Provider Demographics
NPI:1104850874
Name:FRASER, JEAN L (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6358
Mailing Address - Country:US
Mailing Address - Phone:978-521-8680
Mailing Address - Fax:978-521-8790
Practice Address - Street 1:140 LINCOLN AVE
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830
Practice Address - Country:US
Practice Address - Phone:978-521-8680
Practice Address - Fax:978-521-8790
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151910207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3164675Medicaid
MA3164675Medicaid
MAA22284Medicare PIN