Provider Demographics
NPI:1518073972
Name:DIFAZIO, FRANK A (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:DIFAZIO
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 1:507 GILBERTS LNDG
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8345
Mailing Address - Country:US
Mailing Address - Phone:203-273-4610
Mailing Address - Fax:
Practice Address - Street 1:1014 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7177
Practice Address - Country:US
Practice Address - Phone:843-556-5585
Practice Address - Fax:846-556-5587
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT38363207XX0005X
CT038363207XX0801X
LA321517207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61542Medicare UPIN
CT200000970Medicare ID - Type Unspecified