Provider Demographics
NPI:1881807162
Name:MARCELLA A FRAUSTO, MD PA
Entity type:Organization
Organization Name:MARCELLA A FRAUSTO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRAUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-849-9733
Mailing Address - Street 1:12350 MONTWOOD DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5695
Mailing Address - Country:US
Mailing Address - Phone:915-849-9733
Mailing Address - Fax:915-849-9744
Practice Address - Street 1:12350 MONTWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5695
Practice Address - Country:US
Practice Address - Phone:915-849-9733
Practice Address - Fax:915-849-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1576208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB67136Medicare UPIN