Provider Demographics
NPI:1437852373
Name:FREDERICK ADOLF PAOLA MD JD LLC
Entity Type:Organization
Organization Name:FREDERICK ADOLF PAOLA MD JD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-732-1133
Mailing Address - Street 1:9636 MONTELANICO LOOP UNIT 204
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-2146
Mailing Address - Country:US
Mailing Address - Phone:239-595-4976
Mailing Address - Fax:
Practice Address - Street 1:6400 DAVIS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5321
Practice Address - Country:US
Practice Address - Phone:239-624-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty