Provider Demographics
NPI:1477599140
Name:FRASER, ANGELA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:FRASER-REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:701 N BROADWAY
Mailing Address - Street 2:PHELPS MEMORIAL HOSPITAL EMERGENCY PHYSICIANS
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1020
Mailing Address - Country:US
Mailing Address - Phone:914-366-3583
Mailing Address - Fax:914-366-1264
Practice Address - Street 1:701 NORTH BROADWAY
Practice Address - Street 2:PHELPS MEMORIAL HOSPITAL
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-366-1554
Practice Address - Fax:914-366-1264
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179880207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01565113Medicaid
NY96F3474181Medicare PIN
E98546Medicare UPIN