Provider Demographics
NPI:1083961569
Name:FRIDIE, LORRAINE THERESA
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:THERESA
Last Name:FRIDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 HUBBARD RD
Mailing Address - Street 2:202
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:202-547-5354
Mailing Address - Fax:
Practice Address - Street 1:3503 HUBBARD RD
Practice Address - Street 2:202
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20772
Practice Address - Country:US
Practice Address - Phone:202-547-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide