1437155850 NPI number — DR. MATTHEW FRIEDMAN M.D.

Table of content: DR. MATTHEW FRIEDMAN M.D. (NPI 1437155850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437155850 NPI number — DR. MATTHEW FRIEDMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1437155850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 SULLIVAN AVE
Provider Second Line Business Mailing Address:
STE B1
Provider Business Mailing Address City Name:
SOUTH WINDSOR
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06074-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-644-3411
Provider Business Mailing Address Fax Number:
860-644-3346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 SULLIVAN AVE
Provider Second Line Business Practice Location Address:
STE B1
Provider Business Practice Location Address City Name:
SOUTH WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06074-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-644-3411
Provider Business Practice Location Address Fax Number:
860-644-3346
Provider Enumeration Date:
06/21/2005

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: 207Q00000X , with the licence number:  029446 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OR2018 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 029446 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0449971 . This is a "US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 000000035833 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001294462 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00129446200 . This is a "BLUE CARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010029446CT01 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080032208 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: HAP369 . This is a "OXFORD HEALTHPLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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