Provider Demographics
NPI:1386862274
Name:FRATINO, CHRISTA (PAC)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:FRATINO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PLEASANT ST
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5881
Mailing Address - Country:US
Mailing Address - Phone:508-693-5949
Mailing Address - Fax:
Practice Address - Street 1:1438 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3421
Practice Address - Country:US
Practice Address - Phone:518-649-9986
Practice Address - Fax:518-649-9987
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025802363A00000X
MAAP2252363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0001884Medicare PIN