Provider Demographics
NPI:1053382291
Name:DICHIARA, FRANK PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:PATRICK
Last Name:DICHIARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2446 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8182
Mailing Address - Country:US
Mailing Address - Phone:732-255-3636
Mailing Address - Fax:732-864-0176
Practice Address - Street 1:2446 CHURCH RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8182
Practice Address - Country:US
Practice Address - Phone:732-255-3636
Practice Address - Fax:732-864-0176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB34105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2998904Medicaid
NJE81587Medicare UPIN
NJ2998904Medicaid