Provider Demographics
NPI:1013200955
Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity Type:Organization
Organization Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Other - Org Name:DR BRAD FRIEDMANN
Other - Org Type:Other Name
Authorized Official - Title/Position:REGINAL VP
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-6542
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1609 WOODBOURNE RD STE 101
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1520
Practice Address - Country:US
Practice Address - Phone:215-752-8860
Practice Address - Fax:215-752-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005753L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
038676Medicare PIN