Provider Demographics
NPI:1801113220
Name:FRASER, JOANA LOUISE (MD)
Entity type:Individual
Prefix:MRS
First Name:JOANA
Middle Name:LOUISE
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JOANA
Other - Middle Name:LOUISE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:319 LONGWOOD AVE
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5728
Mailing Address - Country:US
Mailing Address - Phone:617-355-3501
Mailing Address - Fax:
Practice Address - Street 1:319 LONGWOOD AVE
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5728
Practice Address - Country:US
Practice Address - Phone:617-355-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256327208000000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics