1265676357 NPI number — DR A FRAZIER LLC

Table of content: (NPI 1265676357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265676357 NPI number — DR A FRAZIER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR A FRAZIER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265676357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2012
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:
301-805-4586
Provider Business Mailing Address Fax Number:
301-805-1505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9821 GREENBELT RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-552-1906
Provider Business Practice Location Address Fax Number:
301-805-1505
Provider Enumeration Date:
04/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
ACQUANETTA
Authorized Official Middle Name:
LAVERNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-552-1801

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: 157411600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011722500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: F912 . This is a "CAREFIRST BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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