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Individual

GORDON W FRIED

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
200 PLAZA CT, SUITE C, EAST STROUDSBURG, PA 18301-8259
(570) 424-9952
(570) 424-0768
Mailing address
200 PLAZA CT, SUITE C, EAST STROUDSBURG, PA 18301-8259
(570) 424-5592

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
OS-007213-E
PA
207RI0011X
Interventional Cardiology Physician
Primary
OS007213E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0012090750005
PA
01
0457628
AETNA
PA
01
075227
1ST PRIORITY
PA
01
2101332
GHI
PA
01
232725862
ALL OTHER INS
PA
Enumeration date
07/07/2005
Last updated
04/29/2009
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