Physician Compare National (NPI:1376530816)

HEALTHCARE PROVIDER: FRAZIER T FORTENBERRY JR. MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376530816
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375533227
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040513001106
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FORTENBERRY
	Individual professional last name
Provider First Name	FRAZIER
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	630 PETER JEFFERSON PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 135
	Group Practice or individual's line 2 address
City	CHARLOTTESVILLE
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	229118630
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490077
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SENTARA MARTHA JEFFERSON HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y