Provider Demographics
NPI:1669436911
Name:FRANKENBERG, FRED WAYNE II (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:WAYNE
Last Name:FRANKENBERG
Suffix:II
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 1:101 DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1342
Mailing Address - Country:US
Mailing Address - Phone:607-274-4011
Mailing Address - Fax:
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-274-4011
Practice Address - Fax:607-274-4198
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA81752208M00000X
NY267226208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003212153AMedicaid
FL266291400Medicaid
FL364516922OtherTAX IDENTIFICATION
FLME86861OtherSTATE MEDICAL LICENSE
FL57648OtherBLUE CROSS BLUE SHIELD
NY57648Medicare PIN