Organization
FRAZIER T FORTENBERRY JR MD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRAZIER T FORTENBERRY JR. MD (OWNER)
(434) 244-5722
Entity
Organization
Contact information
Practice address
630 PETER JEFFERSON PKWY, SUITE 135, CHARLOTTESVILLE, VA 22911-8605
(434) 244-5722
(434) 244-5723
Mailing address
630 PETER JEFFERSON PKWY, SUITE 135, CHARLOTTESVILLE, VA 22911-8605
(434) 244-5722
(434) 244-5723
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA1531
MEDICARE PIN
VA
Enumeration date
07/10/2006
Last updated
08/09/2011
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