Provider Demographics
NPI:1992711667
Name:FRAGNER, PAUL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:FRAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2906
Mailing Address - Country:US
Mailing Address - Phone:914-946-1010
Mailing Address - Fax:914-946-1025
Practice Address - Street 1:222 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-946-1010
Practice Address - Fax:914-946-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177505207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1604613Medicaid
NY60G711Medicare PIN
NYF30969Medicare UPIN