Provider Demographics
NPI:1306892344
Name:FRASER BRANCHE, EMILY (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:FRASER BRANCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:FRASER
Other - Last Name:TENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:314 ELLICOTT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3650
Mailing Address - Country:US
Mailing Address - Phone:585-483-3081
Mailing Address - Fax:585-483-3084
Practice Address - Street 1:314 ELLICOTT ST STE 2
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-483-3081
Practice Address - Fax:585-483-3084
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238232208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02734430Medicaid
2615324OtherUNITED HEALTH CARE
P010238232OtherBLUE CHOICE
186127OtherPREFERRED CARE
7243840OtherAETNA
P020238232OtherEXCELLUS BC BS
1213219OtherINDEPENDENT HEALTH
000528512002OtherCOMMUNITY BLUE
00027621501OtherUNIVERA
NYI50954Medicare UPIN