Provider Demographics
NPI:1235237405
Name:FRAZER, TERESA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ELIZABETH
Last Name:FRAZER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1320 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8016
Mailing Address - Country:US
Mailing Address - Phone:304-647-4411
Mailing Address - Fax:304-645-1439
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:SUITE #201
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-327-1630
Practice Address - Fax:304-327-1660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-03-11
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Provider Licenses
StateLicense IDTaxonomies
WV196212080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010119294Medicaid
WV1808202000Medicaid
D26632Medicare UPIN
WV1808202000Medicaid
VA010119294Medicaid