Provider Demographics
NPI:1215112024
Name:FRAZIER ROSE ANGSTADT
Entity type:Organization
Organization Name:FRAZIER ROSE ANGSTADT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-520-0700
Mailing Address - Street 1:101 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3120
Mailing Address - Country:US
Mailing Address - Phone:610-520-0700
Mailing Address - Fax:610-520-0744
Practice Address - Street 1:101 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3120
Practice Address - Country:US
Practice Address - Phone:610-520-0700
Practice Address - Fax:610-520-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACL2377OtherRAILROAD MEDICARE
PACL2377OtherRAILROAD MEDICARE