Provider Demographics
NPI:1760482921
Name:FRIEDMAN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MOUNT AUBURN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4555
Mailing Address - Country:US
Mailing Address - Phone:617-491-5586
Mailing Address - Fax:617-661-5995
Practice Address - Street 1:625 MOUNT AUBURN ST
Practice Address - Street 2:STE 104
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4555
Practice Address - Country:US
Practice Address - Phone:617-491-5586
Practice Address - Fax:617-661-5995
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA38383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB72808Medicare UPIN
MAB11524Medicare PIN
MA0107395Medicare ID - Type Unspecified