MEDICARE: MR. ALBERT ANGUS FRASER M.D.

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	207L00000X	Anesthesiology Physician	188814	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32061	OTHER	NY	MVP
2	10000687	OTHER	NY	CDPHP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023124716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT ANGUS FRASER M.D.

Provider Business Mailing Address
First Line	:	178 CLIZBE AVE
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-7520
Country	:	US
Telephone Number	:	518-843-8745
Fax Number	:	518-842-9633

Provider Business Practice Location Address
First Line	:	178 CLIZBE AVE
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-7520
Country	:	US
Telephone Number	:	518-843-8745
Fax Number	:	518-842-9633

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	03/24/2011

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