Healthcare Provider Details

I. General information

NPI: 1033313572
Provider Name (Legal Business Name): EVELYN FRAZIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 PETER JEFFERSON PKWY SUITE 130
CHARLOTTESVILLE VA
22911-8618
US

IV. Provider business mailing address

675 PETER JEFFERSON PKWY SUITE 130
CHARLOTTESVILLE VA
22911-8618
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-8242
  • Fax: 434-202-1006
Mailing address:
  • Phone: 434-202-8242
  • Fax: 434-202-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101248280
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number0101248280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: