Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD441084 | PA |
N | 208200000X | Surgeon | MD441084 | PA |
N | 208600000X | Surgeon | MD441084 | PA |
Y | 2086S0129X | Vascular Surgeon | MD441084 | PA |
NPI | 1144218579 |
---|---|
Provider Name | Dr. Gay L Fried |
First Address | Downers Grove, IL 60515-1069 |
Second Address | Trevose, PA 19053-6964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1144218579 | INDIVIDUAL NPI (01) | PA |
199957ZAAQ | GROUP MEMBER PTAN (01) | PA |
8547700 | (05) | NJ |
DO6431 | (02) | PA |
E86108 | (02) | NJ |