Provider Demographics
NPI:1265676357
Name:DR A FRAZIER LLC
Entity Type:Organization
Organization Name:DR A FRAZIER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ACQUANETTA
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-552-1801
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:301-805-4586
Mailing Address - Fax:301-805-1505
Practice Address - Street 1:9821 GREENBELT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2265
Practice Address - Country:US
Practice Address - Phone:301-552-1906
Practice Address - Fax:301-805-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022435207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157411600Medicaid
DC011722500Medicaid
MDF912OtherCAREFIRST BLUE CROSS BLUE SHIELD
DC447486Medicare PIN