Provider Demographics
NPI:1750328308
Name:FRAYHA, RIDA ANIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RIDA
Middle Name:ANIS
Last Name:FRAYHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12 FOX KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2848
Mailing Address - Country:US
Mailing Address - Phone:410-358-2741
Mailing Address - Fax:410-358-5184
Practice Address - Street 1:3640 FORDS LN
Practice Address - Street 2:SUITE E
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2931
Practice Address - Country:US
Practice Address - Phone:410-358-2741
Practice Address - Fax:410-358-5184
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21058207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD429201400Medicaid
MD429201400Medicaid
MD3353Medicare ID - Type Unspecified