Provider Demographics
NPI:1477658193
Name:PROCACCINO, FRANK (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:PROCACCINO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14010 SMOKETOWN RD STE 117
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4722
Mailing Address - Country:US
Mailing Address - Phone:703-580-0181
Mailing Address - Fax:703-897-8763
Practice Address - Street 1:14010 SMOKETOWN RD STE 117
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4722
Practice Address - Country:US
Practice Address - Phone:703-580-0181
Practice Address - Fax:703-897-8763
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055818207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1184719452Medicare UPIN