Individual
DR. FRED WAYNE FRANKENBERG II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4011
(607) 274-4198
Mailing address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4011
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
267226
NY
208M00000X
Hospitalist Physician
81752
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003212153A
—
GA
05
—
266291400
—
FL
01
—
364516922
TAX IDENTIFICATION
FL
01
—
57648
BLUE CROSS BLUE SHIELD
FL
01
—
ME86861
STATE MEDICAL LICENSE
FL
Enumeration date
04/13/2006
Last updated
09/26/2023
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