1811944416 NPI number — TERRY F. KRIEDMAN, MD

Table of content: (NPI 1811944416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811944416 NPI number — TERRY F. KRIEDMAN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRY F. KRIEDMAN, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1811944416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST TISBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02575-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-696-9946
Provider Business Mailing Address Fax Number:
508-696-7155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 STATE ROAD
Provider Second Line Business Practice Location Address:
WOODLAND CENTER
Provider Business Practice Location Address City Name:
VINEYARD HAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02658-7625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-696-9946
Provider Business Practice Location Address Fax Number:
508-696-7155
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRIEDMAN
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-696-9946

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AV95 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17365 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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