1083731269 NPI number — MS. AMANDA PATRICIA FRIES ATC

Table of content: MS. AMANDA PATRICIA FRIES ATC (NPI 1083731269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083731269 NPI number — MS. AMANDA PATRICIA FRIES ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIES
Provider First Name:
AMANDA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083731269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
803 ROUND TOP CT
Provider Second Line Business Mailing Address:
APT 3A
Provider Business Mailing Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-808-8851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5407 ROLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21210-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-323-3800
Provider Business Practice Location Address Fax Number:
410-864-2828
Provider Enumeration Date:
03/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)