Individual
EDWARD A FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000391
CT
363AS0400X
Surgical Physician Assistant
000391
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4024972
—
CT
05
—
4041679
—
CO
Enumeration date
02/19/2007
Last updated
09/11/2025
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