Provider Demographics
NPI:1083816235
Name:FRASER, PAUL K (LICAC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:K
Last Name:FRASER
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GROVE ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-878-2667
Mailing Address - Fax:
Practice Address - Street 1:6 GROVE ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:781-878-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218657171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist