Provider Demographics
NPI:1962468009
Name:FRIEDBERGER, MARYLOUIS (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARYLOUIS
Middle Name:
Last Name:FRIEDBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W NAOMI ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3710
Mailing Address - Country:US
Mailing Address - Phone:215-843-9909
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY & WOODLAND AVE
Practice Address - Street 2:PHILA VA MED CENTER
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-4300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000388L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant