Provider Demographics
NPI:1326107103
Name:FRASER, DOUGLAS JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAMES
Last Name:FRASER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5411A BACKLICK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3915
Mailing Address - Country:US
Mailing Address - Phone:703-256-2474
Mailing Address - Fax:703-941-7938
Practice Address - Street 1:5411A BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-256-2474
Practice Address - Fax:703-941-7938
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023876207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146733OtherMAMSI PROV. NUMBER
1682OtherBCBS NATL CAPITAL PROV NO
2146733OtherMDIPA PROV NUMBER
78521OtherAETNA PROVIDER ID NUMBER
ONENET PPO ALLIANCEOther2146733
08 00148OtherUNITED HEALTH CARE
1682OtherCARE FIRST BC BS
2146733OtherOPTIMUM CHOICE PROV NO
244846OtherNCPPO PROV NUMBER
VA274557OtherANTHEM PROVIDER NUMBER
698420OtherFIRST HEALTH PROV NUMBER
78521OtherAETNA PROVIDER ID NUMBER
698420OtherFIRST HEALTH PROV NUMBER