Provider Demographics
NPI:1366428112
Name:MAROTTA, FREDERIC W (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:W
Last Name:MAROTTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1194 MAE ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9185
Mailing Address - Country:US
Mailing Address - Phone:717-566-6374
Mailing Address - Fax:717-566-6341
Practice Address - Street 1:1194 MAE ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9185
Practice Address - Country:US
Practice Address - Phone:717-566-6374
Practice Address - Fax:717-566-6341
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist