Provider Demographics
NPI:1013095330
Name:FRIED, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FRIED
Suffix:
Gender:M
Credentials:MD
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:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-644-0111
Mailing Address - Fax:336-644-0085
Practice Address - Street 1:1510 NC HIGHWAY 68 N
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9733
Practice Address - Country:US
Practice Address - Phone:336-644-0111
Practice Address - Fax:336-644-0085
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22381OtherPARTNERS MEDICARE
NC77008OtherMEDCOST
NC891111NMedicaid
NC1111NOtherBCBS OF NC
B79860Medicare UPIN
NC891111NMedicaid
NC203372GMedicare PIN