Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 35047371 | OH |
NPI | 1336147982 |
---|---|
Provider Name | Roger Friedman |
First Address | Columbus, OH 43220-2967 |
Second Address | Westerville, OH 43081-8095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0487530 | (05) | OH |
A80410 | (02) |