Basic Information
| Provider Information | |||||||||
| NPI: | 1184662330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRONTINO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820956 | ||||||||
| Address2: | TEMPLE PHYSICIANS INC | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007772455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 E ALLEGHENY AVE | ||||||||
| Address2: | NORTHEASTERN HOSPITAL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154232376 | ||||||||
| FaxNumber: | 2156344872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 09/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS012728 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1184662330 | 05 | DE | MEDICAID | 1602616 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1184662330 | 01 | DE | BLUE CROSS BLUE SHIELD | OTHER | 1008704400002 | 05 | PA | MEDICAID |