Provider Demographics
NPI:1396040739
Name:FRIDLEY, TODD LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LEE
Last Name:FRIDLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 TATE BLVD SE STE 202
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1385
Mailing Address - Country:US
Mailing Address - Phone:828-485-2707
Mailing Address - Fax:828-485-2708
Practice Address - Street 1:1501 TATE BLVD SE STE 202
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1385
Practice Address - Country:US
Practice Address - Phone:828-485-2707
Practice Address - Fax:828-485-2708
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-02053208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty