Provider Demographics
NPI:1356629331
Name:THE FROST MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:THE FROST MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-567-0088
Mailing Address - Street 1:10 E 6TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1784
Mailing Address - Country:US
Mailing Address - Phone:610-567-0088
Mailing Address - Fax:610-567-0881
Practice Address - Street 1:10 E 6TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1784
Practice Address - Country:US
Practice Address - Phone:610-567-0088
Practice Address - Fax:610-567-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA467118261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty