MEDICARE: ALEXA MARIE FRUTH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	825	WV

General Provider Information

NPI Number	:	1568002509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA MARIE FRUTH PA

Provider Business Mailing Address
First Line	:	607 CHESTNUT ST
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1205
Country	:	US
Telephone Number	:	304-766-9136
Fax Number	:	304-766-9139

Provider Business Practice Location Address
First Line	:	607 CHESTNUT ST
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1205
Country	:	US
Telephone Number	:	304-766-9136
Fax Number	:	304-766-9139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	02/21/2023

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