Provider Demographics
NPI:1437155850
Name:FRIEDMAN, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:FRIEDMAN
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 1:1050 SULLIVAN AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2000
Mailing Address - Country:US
Mailing Address - Phone:860-644-3411
Mailing Address - Fax:860-644-3346
Practice Address - Street 1:1050 SULLIVAN AVE
Practice Address - Street 2:STE B1
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2000
Practice Address - Country:US
Practice Address - Phone:860-644-3411
Practice Address - Fax:860-644-3346
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOR2018OtherHEALTHNET
CT029446OtherCONNECTICARE
CT0449971OtherUS HEALTHCARE
CT000000035833OtherWELLCARE
CT001294462Medicaid
CT00129446200OtherBLUE CARE FAMILY PLAN
CT010029446CT01OtherANTHEM BLUE SHIELD
CT080032208OtherRAILROAD MEDICARE
CTHAP369OtherOXFORD HEALTHPLANS
CTOR2018OtherHEALTHNET
CT029446OtherCONNECTICARE