Provider Demographics
NPI:1528202140
Name:FRIEDMAN-KLABANOFF, DEANNA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:JO
Last Name:FRIEDMAN-KLABANOFF
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 1:685 W BALTIMORE ST RM 480
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1509
Mailing Address - Country:US
Mailing Address - Phone:410-706-8695
Mailing Address - Fax:410-706-6205
Practice Address - Street 1:685 W BALTIMORE ST RM 480
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1509
Practice Address - Country:US
Practice Address - Phone:410-706-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53696208000000X
WI64082208000000X
MDD0088021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528202140Medicaid