Provider Demographics
NPI:1558410845
Name:FRY, JUNE M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:M
Last Name:FRY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 CORPORATE PLACE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-535-9757
Practice Address - Street 1:8835 GERMANTOWN AVENUE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2718
Practice Address - Country:US
Practice Address - Phone:610-828-4060
Practice Address - Fax:610-238-5300
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024979E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0080718606Medicaid
PA000807186 0007Medicaid
PAC30974Medicare UPIN
PA000807186 0007Medicaid