Provider Demographics
NPI:1043380140
Name:FRAZIER, ACQUANETTA (MD)
Entity Type:Individual
Prefix:
First Name:ACQUANETTA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
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:PO BOX 77793
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-8793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8723 GREENBELT RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2403
Practice Address - Country:US
Practice Address - Phone:301-552-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022435207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110011605OtherRAILROAD MEDICARE
MD157411600Medicaid
MD2251992OtherAETNA
DC011722500Medicaid
MD28524OtherMAMSI/ALLIANCE
MDF912 0001OtherCAREFIRST
MD110011605OtherRAILROAD MEDICARE
MD28524OtherMAMSI/ALLIANCE