Provider Demographics
NPI:1558338293
Name:FRIDAY, GARY H (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:H
Last Name:FRIDAY
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 1:2063 WHITE HORSE RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2127
Mailing Address - Country:US
Mailing Address - Phone:610-772-5292
Mailing Address - Fax:914-460-8130
Practice Address - Street 1:414 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3311
Practice Address - Country:US
Practice Address - Phone:610-772-5292
Practice Address - Fax:914-460-8130
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-031977-E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00157488OtherMEDICARE RAILROAD
PA0018449700005Medicaid
C31171Medicare UPIN
PA131604Medicare ID - Type Unspecified