Provider Demographics
NPI:1083613459
Name:FRIEDMAN, KENNETH J (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 FRAGILE SAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5022
Mailing Address - Country:US
Mailing Address - Phone:410-461-4914
Mailing Address - Fax:
Practice Address - Street 1:1730 ELTON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1723
Practice Address - Country:US
Practice Address - Phone:301-439-4301
Practice Address - Fax:301-439-4340
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
MD246Q00000X246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD398312Medicare ID - Type Unspecified
MDE13428Medicare UPIN