Provider Demographics
NPI:1073552857
Name:FRASER-HARRIS, EVA V (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:V
Last Name:FRASER-HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:V
Other - Last Name:ALADJEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:FAHC-WP2
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2415
Mailing Address - Fax:802-847-5324
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FAHC-WP2
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2415
Practice Address - Fax:802-847-5324
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009005207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1071Medicaid
NY01551124Medicaid
VTG00066Medicare UPIN
VTVN1071Medicare ID - Type Unspecified