Provider Demographics
NPI:1881621266
Name:FRASER, KEITH EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EVAN
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 EVERGREEN PL
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2011
Mailing Address - Country:US
Mailing Address - Phone:973-678-8144
Mailing Address - Fax:973-678-2830
Practice Address - Street 1:134 EVERGREEN PL
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2011
Practice Address - Country:US
Practice Address - Phone:973-678-8144
Practice Address - Fax:973-678-2830
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ53154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP1278567OtherOXFORD
NJ0K7327OtherHEALTHNET
NJ44430OtherAETNA
NJ0383367000OtherAMERIHEALTH
NJ0980497OtherCIGNA
NJ1018005OtherHORIZON NJ HEALTH
NJ3417301Medicaid
NJ44430OtherAETNA
NJ0383367000OtherAMERIHEALTH