Provider Demographics
NPI:1184652950
Name:FRAZER, CHAD A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:FRAZER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FIRSTVILLAGE DRIVE
Mailing Address - Street 2:PO BOX 2000
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374
Mailing Address - Country:US
Mailing Address - Phone:910-295-6831
Mailing Address - Fax:910-295-0244
Practice Address - Street 1:5 FIRSTVILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-295-6831
Practice Address - Fax:910-295-0244
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02842363AS0400X, 363AS0400X
CT001366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT136600OtherCONNECTICARE
NC0010-02842OtherNCMB
CT290001366CT01OtherBCBS
Q01360Medicare UPIN
NC0010-02842OtherNCMB