Provider Demographics
NPI:1891747069
Name:FRIEDMAN, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
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:GUAM MEDICAL PLAZA
Mailing Address - Street 2:633 GOV. CARLOS CAMACHO RD. STE B5
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3194
Mailing Address - Country:US
Mailing Address - Phone:671-647-4656
Mailing Address - Fax:671-647-4660
Practice Address - Street 1:GUAM MEDICAL PLAZA
Practice Address - Street 2:633 GOV. CARLOS CAMACHO RD. STE B5
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3194
Practice Address - Country:US
Practice Address - Phone:671-647-4656
Practice Address - Fax:671-647-4660
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001476207RH0003X
WAMD 00033258207RH0003X
CAG20360207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUF-0096744Medicaid
H101501Medicare PIN
A-40914Medicare UPIN