Provider Demographics
NPI:1336121268
Name:FRYMOYER, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:FRYMOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 LINKSIDE DR.
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104
Mailing Address - Country:US
Mailing Address - Phone:315-682-4468
Mailing Address - Fax:
Practice Address - Street 1:7650 LINKSIDE DR.
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:315-682-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140841207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000914918001OtherHEALTHNOW
NY00040148603OtherUNIVERA SENIOR CHOICE
NY10119424OtherCDPHP
NY3399723OtherGHI
NY00510527Medicaid
NY110059026OtherRAILROAD MEDICARE
NY950184OtherMVP
NY4535674OtherAETNA
NY100024666301OtherUNITED HEALTHCARE
NY000914918001OtherHEALTHNOW
NY10119424OtherCDPHP
NY34576AMedicare PIN