Provider Demographics
NPI:1891710273
Name:FRY, JAMES RICHARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:FRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 TIPPERARY CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3038
Mailing Address - Country:US
Mailing Address - Phone:513-658-1030
Mailing Address - Fax:
Practice Address - Street 1:2925 VERNON PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2425
Practice Address - Country:US
Practice Address - Phone:513-751-6667
Practice Address - Fax:513-872-4553
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV526363AM0700X
OH1944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FRPA21541Medicare UPIN