Provider Demographics
NPI:1205815024
Name:DRIEDGER, HARRY J (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:J
Last Name:DRIEDGER
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 1:1870 COLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6900
Mailing Address - Country:US
Mailing Address - Phone:740-353-7870
Mailing Address - Fax:740-353-1531
Practice Address - Street 1:1870 COLES BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6900
Practice Address - Country:US
Practice Address - Phone:740-353-7870
Practice Address - Fax:740-353-1531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 043229207RC0000X
KY20487207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000119226OtherANTHEM BC/BS
OH0410648Medicaid
KY64930704Medicaid
0004341984OtherAETNA
25-00343OtherUNITED HEALTH CARE
25-00343OtherUNITED HEALTH CARE
OHA78794Medicare UPIN
OH0463831Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.