Provider Demographics
NPI:1093174732
Name:FRATICELLI, NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:FRATICELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4090
Mailing Address - Fax:717-812-4092
Practice Address - Street 1:25 MONUMENT RD STE 290
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5073
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:717-812-4092
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFF0001987207X00000X
390200000X
PAOS021041207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program