Provider Demographics
NPI:1205922424
Name:FRICKE, WILLIAM ALLEN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:FRICKE
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 1:1425 PORTLAND AVE
Mailing Address - Street 2:ROCHESTER GENERAL HOSPITAL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-4576
Mailing Address - Fax:585-922-4128
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:ROCHESTER GENERAL HOSPITAL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4576
Practice Address - Fax:585-922-4128
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1981281207ZB0001X
NY198128-1207ZP0102X, 207ZP0105X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF91639Medicare UPIN
NYBB3938Medicare ID - Type Unspecified
NYCC0031Medicare ID - Type Unspecified