Provider Demographics
NPI: | 1851319669 |
---|---|
Name: | FRAZIER, ALETTA ANN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ALETTA |
Middle Name: | ANN |
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: | 22 S GREENE ST, DEPT OF RADIOLOGY |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21201-1544 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-328-3477 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 22 S GREENE ST, DEPT OF RADIOLOGY |
Practice Address - Street 2: | |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21201-1544 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-328-3477 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-18 |
Last Update Date: | 2019-04-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D0052249 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DC | 045955237 | Medicaid | |
MD | 800501000 | Medicaid | |
MD | 300116875 | Medicare PIN | |
MD | 300115618 | Medicare PIN | |
MD | 865L71YY | Medicare PIN | |
MD | 29XX | Medicare PIN | |
MD | 800501000 | Medicaid |