Provider Demographics
NPI:1205875549
Name:FRIEDMAN, ROBERT I (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
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 1:54 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1601
Mailing Address - Country:US
Mailing Address - Phone:508-947-8517
Mailing Address - Fax:
Practice Address - Street 1:54 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1601
Practice Address - Country:US
Practice Address - Phone:508-947-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA711365OtherTUFTS
MAFRJ17027OtherBCBSMA
MA6008OtherHARVARD PILGRIM
MA2069059Medicaid
MA711365OtherTUFTS
MAD82935Medicare UPIN