Provider Demographics
NPI:1417951377
Name:FRASCELLA, PAUL ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:FRASCELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2020 W 86TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1931
Mailing Address - Country:US
Mailing Address - Phone:317-871-5900
Mailing Address - Fax:317-872-6439
Practice Address - Street 1:2020 W 86TH ST
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1931
Practice Address - Country:US
Practice Address - Phone:317-871-5900
Practice Address - Fax:317-872-6439
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02001543207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100378530Medicaid
IN180017836OtherRAILROAD MEDICARE
INE54063Medicare UPIN