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Individual

DR. FRAZIER T FORTENBERRY JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

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
0101044989
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14120
COMMUNITY HEALTH
VA
01
204175
SOUTHERN HEALTH
VA
01
23555
CIGNA
VA
01
340000300
MEDICARE
VA
01
367104
MAMSI
VA
01
461522
ANTHEM SERVICES
VA
01
P00003207
MEDICARE PIN
VA
Enumeration date
09/30/2005
Last updated
07/21/2011
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