Provider Demographics
NPI:1124550017
Name:FRATCZAK, ADRIENNE (DO)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:FRATCZAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:ROARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-252-8555
Mailing Address - Fax:
Practice Address - Street 1:1 PHYSICIANS PLAZA
Practice Address - Street 2:
Practice Address - City:LOCHGELLY
Practice Address - State:WV
Practice Address - Zip Code:25866
Practice Address - Country:US
Practice Address - Phone:304-252-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3511207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine