1538151196 NPI number — DR. HUGH ERSKINE FRASER III MD

Table of content: SAHRA CASTILLA (NPI 1689531063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538151196 NPI number — DR. HUGH ERSKINE FRASER III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRASER
Provider First Name:
HUGH
Provider Middle Name:
ERSKINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538151196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2700
Provider Second Line Business Mailing Address:
212 SOUTH MAIN ST., SUITE 4
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-799-8398
Provider Business Mailing Address Fax Number:
434-799-1415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-799-8398
Provider Business Practice Location Address Fax Number:
434-799-1415
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  28973 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33689 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8933689 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 249433 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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