Provider Demographics
NPI:1093047367
Name:FRANK P. FECHNER, MD LLC
Entity Type:Organization
Organization Name:FRANK P. FECHNER, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:P
Authorized Official - Last Name:FECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-754-4000
Mailing Address - Street 1:428 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1661
Mailing Address - Country:US
Mailing Address - Phone:508-754-4000
Mailing Address - Fax:508-754-4222
Practice Address - Street 1:428 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1661
Practice Address - Country:US
Practice Address - Phone:508-754-4000
Practice Address - Fax:508-754-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219725261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFE A37782Medicare UPIN