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
StateLicense IDTaxonomies
MDD00522492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC045955237Medicaid
MD800501000Medicaid
MD300116875Medicare PIN
MD300115618Medicare PIN
MD865L71YYMedicare PIN
MD29XXMedicare PIN
MD800501000Medicaid