Provider Demographics
NPI:1417043589
Name:FRASER, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:50 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-534-4242
Mailing Address - Fax:978-534-3705
Practice Address - Street 1:50 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-534-4241
Practice Address - Fax:978-534-3705
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA46010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN01905OtherBLUE CROSS AND BLUE SHIEL
MA046010OtherTUFTS
MA0136166Medicaid
MA65152OtherHARVARD PILGIRM
MA046010OtherTUFTS
B99028Medicare UPIN