Provider Demographics
NPI:1609985381
Name:FRIEDRICH, MARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:FRIEDRICH
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 1:1801 FAIRFIELD AVENUE STE 207
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-221-8395
Mailing Address - Fax:
Practice Address - Street 1:1801 FAIRFIELD AVENUE STE 207
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-221-8395
Practice Address - Fax:318-424-2826
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359831Medicaid
LAB89440Medicare UPIN
LA4P404CQ62Medicare PIN
LA51350Medicare ID - Type Unspecified