Provider Demographics
NPI:1760475966
Name:FRICKEL, WENDY DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:DOUGLAS
Last Name:FRICKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:PA
Mailing Address - Zip Code:18415
Mailing Address - Country:US
Mailing Address - Phone:570-224-8899
Mailing Address - Fax:570-224-8899
Practice Address - Street 1:101 DATES DRIVE
Practice Address - Street 2:CAYUGA MEDICAL CTR
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02632162Medicaid
NYRB3847Medicare PIN
D87831Medicare UPIN
NY2039P1Medicare ID - Type Unspecified
MDS0343784Medicare ID - Type Unspecified