Provider Demographics
NPI:1568489318
Name:FRIDBERG, MARIANNE FOTIADIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:FOTIADIS
Last Name:FRIDBERG
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-0337
Mailing Address - Country:US
Mailing Address - Phone:410-939-9442
Mailing Address - Fax:
Practice Address - Street 1:510 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3318
Practice Address - Country:US
Practice Address - Phone:410-939-5330
Practice Address - Fax:410-939-6204
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD224332080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4283566OtherAETNA PPO
MDS951OtherBLUECROSS/BLUESHIELD
MD897793OtherAETNA HMO
MD1377684OtherFIRST HEALTH
MD817508OtherMAMSI
MDT7960001OtherCAREFIRST BLUECHOICE
MD2809440371OtherCOVENTRY
MDD31441Medicare UPIN