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General NPI Number Information
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NPI Number | 1336329762
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Entity Type | Individual
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Provider Name | JOE WENDELL FRAZIER PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 10 N GREENE ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1524
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Country | US
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Telephone | 410-604-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 3536 HOOPER RD
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City | NEW WINDSOR
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State | MD
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Zip | 21776-8112
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Country | US
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Telephone | 410-775-5556
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Fax | 410-775-5556
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA030423
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA030423
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License Number State | DC
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