Provider Demographics
NPI:1184791964
Name:FRAUMAN, DAVID CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:FRAUMAN
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 1:6367 N GUILFORD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1749
Mailing Address - Country:US
Mailing Address - Phone:317-255-7009
Mailing Address - Fax:317-255-0850
Practice Address - Street 1:6367 N GUILFORD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1749
Practice Address - Country:US
Practice Address - Phone:317-255-7009
Practice Address - Fax:317-255-0850
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040002A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
010681OtherVALUE OPTIONS
000000176173OtherANTHEM BLUE CROSS BLUE SH
IN090650Medicare ID - Type Unspecified