Provider Demographics
NPI:1851745517
Name:FRIEDMAN, JESSICA LAUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LAUREN
Last Name:FRIEDMAN
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 1:421 FALLSWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4800
Mailing Address - Country:US
Mailing Address - Phone:443-703-1447
Mailing Address - Fax:410-837-8020
Practice Address - Street 1:421 FALLSWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4800
Practice Address - Country:US
Practice Address - Phone:410-837-5533
Practice Address - Fax:443-703-5638
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD89371207Q00000X
NC2018-02544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383841200Medicaid