Provider Demographics
NPI:1598723421
Name:KRIEDMAN, TERRY F (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:F
Last Name:KRIEDMAN
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 1380
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-1380
Mailing Address - Country:US
Mailing Address - Phone:508-696-9946
Mailing Address - Fax:
Practice Address - Street 1:455 STATE RD
Practice Address - Street 2:WOODLAND CENTER
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5695
Practice Address - Country:US
Practice Address - Phone:508-696-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155754207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ21903OtherBLUE CROSS MA
MAJ21903OtherBLUE CROSS MA