Provider Demographics
NPI:1831169820
Name:RESCORLA, FREDERICK J (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J
Last Name:RESCORLA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:705 RILEY HOSPITAL DR
Mailing Address - Street 2:STE 2500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-274-4681
Mailing Address - Fax:317-274-4491
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:STE 2500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-4681
Practice Address - Fax:317-274-4491
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-01-27
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Provider Licenses
StateLicense IDTaxonomies
IN01031794A2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100086480Medicaid
IN100086480Medicaid
D95355Medicare UPIN