Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | D0022435 | MD |
NPI | 1043380140 |
---|---|
Provider Name | Acquanetta Frazier |
First Address | Washington, DC 20013-8793 |
Second Address | Greenbelt, MD 20770-2403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 18/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011722500 | (05) | DC |
110011605 | RAILROAD MEDICARE (01) | MD |
157411600 | (05) | MD |
2251992 | AETNA (01) | MD |
28524 | MAMSI/ALLIANCE (01) | MD |
D09632 | (02) | |
F912 0001 | CAREFIRST (01) | MD |