Provider Demographics
NPI:1528332467
Name:FRAZIER, CALEB R (RD, LDN)
Entity type:Individual
Prefix:MR
First Name:CALEB
Middle Name:R
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1225
Mailing Address - Country:US
Mailing Address - Phone:215-481-4143
Mailing Address - Fax:215-481-6790
Practice Address - Street 1:2729 BLAIR MILL RD STE E
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1042
Practice Address - Country:US
Practice Address - Phone:215-672-0899
Practice Address - Fax:215-672-5108
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5980133V00000X
PADN006890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN00AWOtherFL BLUE
FLFV422ZOtherMEDICARE