Individual
DR. PHILIP J. FRACCOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5100 W TAFT RD, SUITE 2A, LIVERPOOL, NY 13088-3807
(315) 452-2555
(315) 452-2559
Mailing address
4567 CROSSROADS PARK DR, 2ND FLOOR, LIVERPOOL, NY 13088-3589
(315) 295-2100
(315) 295-2125
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
173758
NY
2085R0202X
Diagnostic Radiology Physician
MD61497216
WA
2085R0202X
Diagnostic Radiology Physician
ME147948
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00555440
—
NY
05
—
00555500
—
NY
05
—
01334321
—
NY
05
—
02224500
—
NY
Enumeration date
08/16/2005
Last updated
08/30/2024
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