Provider Demographics
NPI:1588725022
Name:FRUCHTER, HAROLD J (PAC)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:J
Last Name:FRUCHTER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:2424 REEDIE DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4624
Practice Address - Country:US
Practice Address - Phone:301-962-6173
Practice Address - Fax:301-962-5733
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC01676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31183Medicare UPIN
004689M92Medicare ID - Type Unspecified