Basic Information
| Provider Information | |||||||||
| NPI: | 1962502492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FROST | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 E BUTLER PIKE | ||||||||
| Address2: | |||||||||
| City: | AMBLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105241552 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 722 E BUTLER PIKE | ||||||||
| Address2: | |||||||||
| City: | AMBLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105241552 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | MD422560 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1012797600001 | 05 | PW | MEDICAID |