Provider Demographics
NPI:1376502534
Name:FRASER, ROBERT W III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:FRASER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2839
Practice Address - Country:US
Practice Address - Phone:704-355-2272
Practice Address - Fax:704-355-1865
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC235292085R0001X
SC139342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC33695OtherBLUE CROSS
NC0952105007OtherCIGNA
NC26020OtherPARTNERS
NC2086502OtherUNITED HEALTHCARE
NC62130OtherMEDCOST
NC8933695Medicaid
SCN23529Medicaid
NC212172HOtherMEDICARE PTAN
NC33695OtherBLUE CROSS
SC300023599Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC212172GMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR
NC212172EMedicare ID - Type UnspecifiedLAKE NORMAN RAD CTR
NC26020OtherPARTNERS
NC212172HOtherMEDICARE PTAN
NC62130OtherMEDCOST