Provider Demographics
NPI:1164504247
Name:FRASER, RICHARD ARNOLD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ARNOLD
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 SHAW'S COVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4906
Mailing Address - Country:US
Mailing Address - Phone:860-443-0622
Mailing Address - Fax:860-443-5531
Practice Address - Street 1:3 SHAW'S COVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4906
Practice Address - Country:US
Practice Address - Phone:860-443-0622
Practice Address - Fax:860-443-5531
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT017854208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D88850Medicare UPIN