Healthcare Provider Details

I. General information

NPI: 1184652950
Provider Name (Legal Business Name): CHAD A FRAZER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FIRSTVILLAGE DRIVE
PINEHURST NC
28374
US

IV. Provider business mailing address

5 FIRSTVILLAGE DRIVE PO BOX 2000
PINEHURST NC
28374
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-6831
  • Fax: 910-295-0244
Mailing address:
  • Phone: 910-295-6831
  • Fax: 910-295-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-02842
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier136600
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCONNECTICARE
# 2
Identifier0010-02842
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNCMB
# 3
Identifier290001366CT01
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: