Provider Demographics
NPI:1881671345
Name:FRADEL, AMY M (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:FRADEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5505
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:
Practice Address - Street 1:1111 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5505
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO32359163W00000X
WI7655363LF0000X
MECNP81518363LF0000X
IN71007240A363LF0000X
MDAC001746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
012002OtherANTHEM OF ME
ME431729399Medicaid
M6491Medicare ID - Type Unspecified