Provider Demographics
NPI:1649316894
Name:FRASER, ALLEYNE (MD)
Entity type:Individual
Prefix:
First Name:ALLEYNE
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5801
Mailing Address - Country:US
Mailing Address - Phone:845-343-0139
Mailing Address - Fax:
Practice Address - Street 1:9 LIVINGSTON ST
Practice Address - Street 2:SUITE 5S
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4719
Practice Address - Country:US
Practice Address - Phone:845-343-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164706207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG12677Medicare UPIN
NY275991Medicare ID - Type Unspecified