Provider Demographics
NPI:1073560447
Name:FASANO, FRANK J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:FASANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3674
Mailing Address - Country:US
Mailing Address - Phone:937-865-9000
Mailing Address - Fax:937-865-9002
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3674
Practice Address - Country:US
Practice Address - Phone:937-865-9000
Practice Address - Fax:937-865-9002
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056645207XX0004X, 207XX0005X, 207XX0801X, 207X00000X, 207XS0106X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699150Medicaid
OHFA0614351Medicare ID - Type Unspecified
OHA17387Medicare UPIN
OH0699150Medicaid
OHH012540Medicare PIN