Provider Demographics
NPI:1740389790
Name:FRIES, ERIN R (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:R
Last Name:FRIES
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 1:212 W SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4137
Mailing Address - Country:US
Mailing Address - Phone:513-771-7213
Mailing Address - Fax:513-771-4356
Practice Address - Street 1:212 W SHARON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4137
Practice Address - Country:US
Practice Address - Phone:513-771-7213
Practice Address - Fax:513-771-4356
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2489427Medicaid
BT8540343OtherDEA NUMBER
OH4136715Medicare PIN
I09905Medicare UPIN