Provider Demographics
NPI:1548600075
Name:FRIEDMAN, WENDY (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:FRIEDMAN
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 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-252-8324
Mailing Address - Fax:304-252-7372
Practice Address - Street 1:252 RURAL ACRES DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3503
Practice Address - Country:US
Practice Address - Phone:304-252-8324
Practice Address - Fax:304-252-7372
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV5043AMedicare PIN