Basic Information
Provider Information
NPI: 1508861105
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRASER
FirstName: DONALD
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1072 X RAY DR
Address2:  
City: GASTONIA
State: NC
PostalCode: 280547498
CountryCode: US
TelephoneNumber: 7046711094
FaxNumber: 7046711095
Practice Location
Address1: 309 S SHARON AMITY RD STE 200
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282112886
CountryCode: US
TelephoneNumber: 7043448846
FaxNumber: 7043449844
Other Information
ProviderEnumerationDate: 06/20/2005
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X25287NCY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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