Provider Demographics
NPI:1174510820
Name:FRIEDMAN, MELISSA A (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:FRIEDMAN
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 1:6853 SW 18TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7056
Mailing Address - Country:US
Mailing Address - Phone:561-368-3775
Mailing Address - Fax:561-392-7139
Practice Address - Street 1:6853 SW 18TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7056
Practice Address - Country:US
Practice Address - Phone:561-368-3775
Practice Address - Fax:561-392-7139
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79567Medicare UPIN
E12142Medicare ID - Type Unspecified