MEDICARE: DONALD D. FRASER, M.D., P.A.

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	261QM2500X	Medical Specialty Clinic/Center	200001959270	NC

General Provider Information

NPI Number	:	1851609093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD D. FRASER, M.D., P.A.

Provider Business Mailing Address
First Line	:	1901 BRUNSWICK AVE
Second Line	:	SUITE 240
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2809
Country	:	US
Telephone Number	:	704-377-3299
Fax Number	:	704-376-6644

Provider Business Practice Location Address
First Line	:	1901 BRUNSWICK AVE
Second Line	:	SUITE 240
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2809
Country	:	US
Telephone Number	:	704-377-3299
Fax Number	:	704-376-6644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD DOYLE FRASER
Credential	:	M.D.
Telephone Number	:	704-377-3299

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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