Provider Demographics
NPI:1023042538
Name:FRIES, MARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:FRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:
Practice Address - Street 1:30 HAGEN DR STE 310
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-641-0400
Practice Address - Fax:585-391-3785
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02162930Medicaid
NYH45994Medicare UPIN
NYCC7684Medicare PIN