MEDICARE: DR. DONALD D FRASER MD

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	207N00000X	Dermatology Physician	25287	NC

General Provider Information

NPI Number	:	1508861105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD D FRASER MD

Provider Business Mailing Address
First Line	:	1072 X RAY DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-7498
Country	:	US
Telephone Number	:	704-671-1094
Fax Number	:	704-671-1095

Provider Business Practice Location Address
First Line	:	309 S SHARON AMITY RD STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2886
Country	:	US
Telephone Number	:	704-344-8846
Fax Number	:	704-344-9844

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/21/2022

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