Provider Demographics
NPI:1942429360
Name:FRATTAROLI, ELIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIO
Middle Name:J
Last Name:FRATTAROLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE BALA AVE
Mailing Address - Street 2:SUITE #210
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3207
Mailing Address - Country:US
Mailing Address - Phone:610-667-2247
Mailing Address - Fax:610-667-6042
Practice Address - Street 1:ONE BALA AVE
Practice Address - Street 2:SUITE #210
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3207
Practice Address - Country:US
Practice Address - Phone:610-667-2247
Practice Address - Fax:610-667-6042
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022460-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38925Medicare UPIN
FR139354Medicare ID - Type Unspecified