Provider Demographics
NPI:1396829495
Name:FRASER, TARA K (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:K
Last Name:FRASER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MICHELA WAY
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290-5309
Mailing Address - Country:US
Mailing Address - Phone:603-679-2284
Mailing Address - Fax:
Practice Address - Street 1:425 ROUTE 125
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825
Practice Address - Country:US
Practice Address - Phone:603-664-9003
Practice Address - Fax:603-664-7205
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH409363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAP1596Medicare ID - Type Unspecified
NHP47190Medicare UPIN