Provider Demographics
NPI:1891786232
Name:FRACASSO, PAUL ERNEST (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERNEST
Last Name:FRACASSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1140
Mailing Address - Country:US
Mailing Address - Phone:330-925-4911
Mailing Address - Fax:330-927-9258
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1140
Practice Address - Country:US
Practice Address - Phone:330-925-4911
Practice Address - Fax:330-927-9258
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004162F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694682Medicaid
OHFR0610537OtherMEDICARE ID
OH0601538OtherMEDICARE ID
OH0748927Medicaid
OHFR0610537OtherMEDICARE ID