Provider Demographics
NPI:1699861633
Name:LEOMINSTER MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:LEOMINSTER MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-534-4241
Mailing Address - Street 1:50 MEMORIAL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-534-4241
Mailing Address - Fax:978-534-3705
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-534-4241
Practice Address - Fax:978-534-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9723269Medicaid
MA600543OtherGRP TUFTS HEALTH PLAN
MA600543OtherGRP TUFTS HEALTH PLAN