Provider Demographics
NPI:1760422422
Name:FRIED, FERN G (MD)
Entity Type:Individual
Prefix:DR
First Name:FERN
Middle Name:G
Last Name:FRIED
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 1:903 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5515
Mailing Address - Country:US
Mailing Address - Phone:215-579-6155
Mailing Address - Fax:215-860-0723
Practice Address - Street 1:903 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5515
Practice Address - Country:US
Practice Address - Phone:215-579-6155
Practice Address - Fax:215-860-0723
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050478L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA753815PNTMedicare ID - Type Unspecified
PAF95003Medicare UPIN