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NPI Code Detail

MEDICARE: DR. SUSAN FRAYER MD

MEDICARE: DR. SUSAN FRAYER 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
1207P00000XEmergency Medicine Physician01050884AIN
2208000000XPediatrics Physician01050884AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598757684
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN FRAYER MD
Provider Business Mailing Address
First Line : 416 E MAUMEE ST
Second Line :
City : ANGOLA
State : IN
Zip : 46703-2015
Country : US
Telephone Number : 260-667-5131
Fax Number : 260-665-7803
Provider Business Practice Location Address
First Line : 306 E MAUMEE ST STE 303
Second Line :
City : ANGOLA
State : IN
Zip : 46703-2044
Country : US
Telephone Number : 260-667-5685
Fax Number : 260-667-5564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 01/28/2020

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Directions to “ DR. SUSAN FRAYER MD” Practice Location

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