Provider Demographics
NPI:1841298064
Name:AMICO, FRANK JOSEPH SR (DO)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOSEPH
Last Name:AMICO
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:516-827-3119
Practice Address - Street 1:5849 HARBOR VIEW BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3769
Practice Address - Country:US
Practice Address - Phone:757-394-1390
Practice Address - Fax:757-800-3282
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2024-12-18
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NY138678207R00000X
VA0102206547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19292Medicare UPIN
77A861Medicare ID - Type Unspecified