Provider Demographics
NPI:1467569590
Name:TALARICO, FRED L (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:L
Last Name:TALARICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5932
Mailing Address - Country:US
Mailing Address - Phone:315-733-1148
Mailing Address - Fax:315-733-0985
Practice Address - Street 1:2115 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5932
Practice Address - Country:US
Practice Address - Phone:315-733-1148
Practice Address - Fax:315-733-0985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1445061207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
60054OtherAETNA
NY00966463Medicaid
87226OtherAETNA LIFE INS CO
99709OtherADMINISTAR CHAMPUS
60054OtherAETNA PPO
60054OtherAETNA US HEALTHCARE
16105OtherAHP CLAIMS DEPARTMENT
60054OtherAETNA LIFE INS CO AHP
60054OtherAETNA INS CO
60054OtherAETNA US HEALTH CARE
98999OtherAARRP UNITED HEALTH CARE
35175OtherADMINISTAR CHAMPUS
60054OtherAETNA LIFE INS CO
16140OtherAPA PARTNERS
60054OtherAETNA LIFE INS
60054OtherAETNA INC
16140OtherAPA PARTNERS INC
99116OtherAHP CLAIMS DEPARTMENT MSP
60054OtherAETNA
60054OtherAETNA INS CO