Healthcare Provider Details

I. General information

NPI: 1346226578
Provider Name (Legal Business Name): THOMAS MARK FRATES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HAWTHORNE DR
BEDFORD NH
03110-6912
US

IV. Provider business mailing address

4 HAWTHORNE DR
BEDFORD NH
03110-6912
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-8888
  • Fax: 603-472-9090
Mailing address:
  • Phone: 603-472-8888
  • Fax: 603-472-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number12874
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: