Provider Demographics
NPI:1629754379
Name:FRITSON, MICHAELA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:FRITSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:MARIE
Other - Last Name:MASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4406 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3116
Mailing Address - Country:US
Mailing Address - Phone:513-376-7116
Mailing Address - Fax:
Practice Address - Street 1:4406 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-3116
Practice Address - Country:US
Practice Address - Phone:513-376-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program