Provider Demographics
NPI:1952483182
Name:FRAZIER, THOMAS GIBSON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GIBSON
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3120
Mailing Address - Country:US
Mailing Address - Phone:610-520-0700
Mailing Address - Fax:610-520-0744
Practice Address - Street 1:101 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3120
Practice Address - Country:US
Practice Address - Phone:610-520-0700
Practice Address - Fax:610-520-0744
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010949E2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB33226Medicare UPIN
PA0014419950003Medicaid
PA018878HK1Medicare PIN