1043380140 NPI number — ACQUANETTA FRAZIER M.D.

Table of content: ACQUANETTA FRAZIER M.D. (NPI 1043380140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043380140 NPI number — ACQUANETTA FRAZIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAZIER
Provider First Name:
ACQUANETTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043380140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77793
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20013-8793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8723 GREENBELT RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-552-9797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  D0022435 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110011605 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 157411600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2251992 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 011722500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28524 . This is a "MAMSI/ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F912 0001 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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