Provider Demographics
NPI:1134638703
Name:FRASER, KEVIN OMAR SR
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:OMAR
Last Name:FRASER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6405
Mailing Address - Country:US
Mailing Address - Phone:718-810-6438
Mailing Address - Fax:
Practice Address - Street 1:1691 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6405
Practice Address - Country:US
Practice Address - Phone:718-810-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)