Provider Demographics
NPI:1700960705
Name:FRICKE, RUSSELL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ALAN
Last Name:FRICKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:107 NOTT TER
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-3170
Mailing Address - Country:US
Mailing Address - Phone:518-386-2810
Mailing Address - Fax:518-382-5418
Practice Address - Street 1:600 FRANKLIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2100
Practice Address - Country:US
Practice Address - Phone:518-346-2187
Practice Address - Fax:518-346-2191
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY188119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01324890Medicaid
F26193Medicare ID - Type Unspecified