Healthcare Provider Details

I. General information

NPI: 1306844212
Provider Name (Legal Business Name): DENISE M FRASER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE M MACK

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL ROAD
OAK BLUFFS MA
02557-1477
US

IV. Provider business mailing address

ONE HOSPITAL ROAD P.O. BOX 1477
OAK BLUFFS MA
02557-1477
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-0410
  • Fax: 508-693-5971
Mailing address:
  • Phone: 508-693-0410
  • Fax: 508-693-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number214813
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number214813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: