Provider Demographics
NPI:1295920445
Name:ROGER D. FRIEDMAN, MD.,INC.
Entity type:Organization
Organization Name:ROGER D. FRIEDMAN, MD.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-783-9700
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1502
Mailing Address - Country:US
Mailing Address - Phone:818-783-9700
Mailing Address - Fax:818-784-2900
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 131
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-783-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C318650Medicaid
CAW2889OtherMEDICARE GROUP
CAW2889OtherMEDICARE GROUP