Provider Demographics
NPI:1417932013
Name:FRIBERG, MARTHA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:FRIBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BAXTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1823
Mailing Address - Country:US
Mailing Address - Phone:207-775-6381
Mailing Address - Fax:207-775-3378
Practice Address - Street 1:43 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1823
Practice Address - Country:US
Practice Address - Phone:207-775-6381
Practice Address - Fax:207-775-3378
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME962207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002296OtherANTHEM BLUE SHIELD
ME040924OtherANTHEM BLUE SHIELD
ME2727288OtherCIGNA INDIV PROV #
NHM2672OtherNEWHAMPSHIRE CIGNA
ME2427080OtherAETNA
MECH8191OtherRAILROAD MCARE GROUP #
ME040924OtherANTHEM BLUE SHIELD
ME2427080OtherAETNA
NHM2672OtherNEWHAMPSHIRE CIGNA