Provider Demographics
NPI:1447362272
Name:FRATTALI, MARY JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JENNIFER
Last Name:FRATTALI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:503 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411
Practice Address - Country:US
Practice Address - Phone:570-587-5186
Practice Address - Fax:570-586-7973
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047963L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FR427966OtherHIGH MARK BLUE SHIELD
PA001393010Medicaid
13683OtherGEISINGER HEALTH PLAN
078837OtherFIRST PRIORITY HEALTH
506554OtherAETNA
180018745OtherRAILROAD MEDICARE
F45617Medicare UPIN
078837OtherFIRST PRIORITY HEALTH