1033192810 NPI number — AMY JO REED FRIEDMAN M.D.

Table of content: AMY JO REED FRIEDMAN M.D. (NPI 1033192810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033192810 NPI number — AMY JO REED FRIEDMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED FRIEDMAN
Provider First Name:
AMY
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
AMY
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033192810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3535 GRANGER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-1538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-666-3400
Provider Business Mailing Address Fax Number:
216-201-6347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 EMBASSY PKWY
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-8387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-664-8181
Provider Business Practice Location Address Fax Number:
330-664-8185
Provider Enumeration Date:
11/25/2005

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:  35073001R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2126701 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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