Provider Demographics
NPI:1003802364
Name:FRYER, THERESA J (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:J
Last Name:FRYER
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 1:3317 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2558
Mailing Address - Country:US
Mailing Address - Phone:814-868-8531
Mailing Address - Fax:814-866-1439
Practice Address - Street 1:3317 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2558
Practice Address - Country:US
Practice Address - Phone:814-868-8531
Practice Address - Fax:814-866-1439
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031915E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411466Medicare ID - Type Unspecified
PAE10414Medicare UPIN