Provider Demographics
NPI:1669464913
Name:FRIEDMAN, MALCOLM B (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:B
Last Name:FRIEDMAN
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 1:127 SANDQUIST CIR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2650
Mailing Address - Country:US
Mailing Address - Phone:203-288-2800
Mailing Address - Fax:
Practice Address - Street 1:127 SANDQUIST CIR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2650
Practice Address - Country:US
Practice Address - Phone:203-288-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0246042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001246041Medicaid
CT001246041Medicaid
B38260Medicare UPIN