Individual
JOHN A FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2200
Mailing address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2200
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35.067223
OH
207RI0011X
Interventional Cardiology Physician
01054133A
IN
207RI0011X
Interventional Cardiology Physician
Primary
35.067223
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200326320
—
IN
01
—
374005
ANTHEM PROVIDER NUMBER
IN
Enumeration date
12/06/2006
Last updated
11/08/2022
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