Healthcare Provider Details

I. General information

NPI: 1689775918
Provider Name (Legal Business Name): TROY D. FRAZER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 FLANDERS RD
NIANTIC CT
06357-1206
US

IV. Provider business mailing address

179 FLANDERS RD
NIANTIC CT
06357-1206
US

V. Phone/Fax

Practice location:
  • Phone: 860-949-3040
  • Fax:
Mailing address:
  • Phone: 860-949-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: