1306892344 NPI number — DR. EMILY FRASER BRANCHE M.D.

Table of content: DR. EMILY FRASER BRANCHE M.D. (NPI 1306892344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306892344 NPI number — DR. EMILY FRASER BRANCHE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRASER BRANCHE
Provider First Name:
EMILY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TENNEY
Provider Other First Name:
EMILY
Provider Other Middle Name:
FRASER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306892344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 ELLICOTT ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-3650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-483-3081
Provider Business Mailing Address Fax Number:
585-483-3084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 ELLICOTT ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-483-3081
Provider Business Practice Location Address Fax Number:
585-483-3084
Provider Enumeration Date:
05/25/2006

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: 208000000X , with the licence number:  238232 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02734430 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2615324 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010238232 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 186127 . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7243840 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020238232 . This is a "EXCELLUS BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1213219 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528512002 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00027621501 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".




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