Provider Demographics
NPI:1760543441
Name:FRASER, MICHAEL DUNCAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DUNCAN
Last Name:FRASER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E 70TH ST
Mailing Address - Street 2:APT 1FE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5116
Mailing Address - Country:US
Mailing Address - Phone:918-886-4063
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST UNIT 4A
Practice Address - Street 2:LINCOLN HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015307OtherNEW YORK STATE LICENSE ID
NY340810Medicaid