Provider Demographics
NPI:1467941633
Name:FRAZIER, ELLEN LEE BERRY (DO)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LEE BERRY
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DO
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 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:
Practice Address - Street 1:2585 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1642
Practice Address - Country:US
Practice Address - Phone:304-781-5138
Practice Address - Fax:304-781-5139
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine