Provider Demographics
NPI:1760557201
Name:E. GLENN FRIEDMAN, D.O., P.C.
Entity Type:Organization
Organization Name:E. GLENN FRIEDMAN, D.O., P.C.
Other - Org Name:MARKET STREET FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7171-755-0633
Mailing Address - Street 1:1900 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2890
Mailing Address - Country:US
Mailing Address - Phone:717-755-0633
Mailing Address - Fax:717-755-8774
Practice Address - Street 1:1900 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2890
Practice Address - Country:US
Practice Address - Phone:717-755-0633
Practice Address - Fax:717-755-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-003931-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097207Medicare ID - Type UnspecifiedMEDICARE NUMBER
PAE70559Medicare UPIN