Individual
MARTIN B FRIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
490 NORTHAMPTON ST, GATEWAY SUITE 1, EDWARDSVILLE, PA 18704-4551
(570) 288-8100
(570) 288-7987
Mailing address
490 NORTHAMPTON ST, GATEWAY SUITE 1, EDWARDSVILLE, PA 18704-4551
(570) 288-8100
(570) 288-7987
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD020746E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027970
MEDICARE PROVIDER #
PA
Enumeration date
05/03/2006
Last updated
08/31/2011
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