Provider Demographics
NPI:1710989751
Name:FRIED, ROBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:FRIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PRINCESS DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2190
Mailing Address - Country:US
Mailing Address - Phone:606-922-3103
Mailing Address - Fax:606-922-3103
Practice Address - Street 1:613 23RD ST STE 210
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2868
Practice Address - Country:US
Practice Address - Phone:606-326-9847
Practice Address - Fax:606-324-3418
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122826208G00000X
KY37173208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292648Medicaid
KY64044886Medicaid
KYCJ6802OtherPALMETTO
WV2001417000Medicaid
KY0690672Medicare ID - Type Unspecified
KY64044886Medicaid
KYK054450Medicare PIN