Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 37877 | MA |
NPI | 1003983529 |
---|---|
Provider Name | Mark R Friedman |
First Address | Foxboro, MA 02035-2074 |
Second Address | Norwood, MA 02062-3316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9715274 | (05) | MA |
E02081 | (02) | MA |