1407884976 NPI number — CHRISTIAN FRAS

Table of content: CHRISTIAN FRAS (NPI 1407884976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407884976 NPI number — CHRISTIAN FRAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAS
Provider First Name:
CHRISTIAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407884976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SPROUL RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-353-5079
Provider Business Mailing Address Fax Number:
484-427-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SPROUL RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-427-8100
Provider Business Practice Location Address Fax Number:
484-427-8103
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD424663 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000308051 . This is a "UNISON-DELAWARE COMMERCIAL MCO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 615900300 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9889702 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2307113000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2522492 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 101083593 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1631494 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30076180 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101083593 0009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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