Provider Demographics
NPI:1952455701
Name:FRIEDRICH, BRIAN G (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
Last Name:FRIEDRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 STATE RD
Mailing Address - Street 2:SUITE 2-400
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4605
Mailing Address - Country:US
Mailing Address - Phone:610-394-1350
Mailing Address - Fax:610-394-1356
Practice Address - Street 1:5030 STATE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4605
Practice Address - Country:US
Practice Address - Phone:610-394-1350
Practice Address - Fax:610-394-1356
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006599L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001208130Medicaid
PA654652Medicare ID - Type Unspecified
PA001208130Medicaid