Provider Demographics
NPI:1609430644
Name:FRATTAROLI, PAOLA (MD)
Entity type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:
Last Name:FRATTAROLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 NW 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2414
Mailing Address - Country:US
Mailing Address - Phone:305-827-2977
Mailing Address - Fax:305-820-6374
Practice Address - Street 1:2230 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2414
Practice Address - Country:US
Practice Address - Phone:305-827-2977
Practice Address - Fax:305-820-6374
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2024-08-29
Deactivation Date:2019-12-09
Deactivation Code:
Reactivation Date:2019-12-16
Provider Licenses
StateLicense IDTaxonomies
FLME165978207R00000X
FLTRN29489390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine