MEDICARE: FRAZIER MEDICAL ASSOCIATES, LLC

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	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1588996607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRAZIER MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1432 HYLAN BLVD
Second Line	:	2ND FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1923
Country	:	US
Telephone Number	:	718-980-6868
Fax Number	:	718-351-0579

Provider Business Practice Location Address
First Line	:	1432 HYLAN BLVD
Second Line	:	2ND FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1923
Country	:	US
Telephone Number	:	718-980-6868
Fax Number	:	718-351-0579

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HAWWA S. FRAZIER
Credential	:	DO
Telephone Number	:	718-980-6868

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	02/01/2010

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