Provider Demographics
NPI:1578949988
Name:FRASER - BRANCHE MEDICAL, PLLC
Entity Type:Organization
Organization Name:FRASER - BRANCHE MEDICAL, PLLC
Other - Org Name:THREE LITTLE BIRDS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER- BRANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-483-3087
Mailing Address - Street 1:314 ELLICOTT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-483-3081
Mailing Address - Fax:585-483-3084
Practice Address - Street 1:314 ELLICOTT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-483-3081
Practice Address - Fax:585-483-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238232174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty