Provider Demographics
NPI:1790208882
Name:FRICKE, GEORGE CHARLES
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:CHARLES
Last Name:FRICKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2516
Mailing Address - Country:US
Mailing Address - Phone:904-673-1037
Mailing Address - Fax:
Practice Address - Street 1:159 TROUT AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-0634
Practice Address - Country:US
Practice Address - Phone:904-673-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman