MEDICARE: DR. KATHLEEN FRAGA MD

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	207P00000X	Emergency Medicine Physician	ME118659	FL
2	207P00000X	Emergency Medicine Physician	MD437917	PA

General Provider Information

NPI Number	:	1346411121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN FRAGA MD

Provider Business Mailing Address
First Line	:	1960 POINTE WEST DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-226-4250
Fax Number	:	772-226-4253

Provider Business Practice Location Address
First Line	:	1960 POINTE WEST DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-226-4250
Fax Number	:	772-226-4253

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

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	02/27/2015

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