Provider Demographics
NPI:1336170711
Name:FRIEDMAN, NEAL MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:MATTHEW
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 1:1399 WEIMER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6349
Mailing Address - Country:US
Mailing Address - Phone:575-758-2224
Mailing Address - Fax:575-758-4903
Practice Address - Street 1:1399 WEIMER RD STE 200
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6349
Practice Address - Country:US
Practice Address - Phone:575-758-2224
Practice Address - Fax:575-758-4903
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015440E207R00000X, 207RE0101X
NM78-162207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001850815Medicaid
PA104974OtherJOHNS HOPKINS
PA50018549OtherCAPITAL BLUE CROSS-WMG
PA7285258OtherAETNA
PA135681OtherUNISON-WMG
PA100447OtherGEISINGER
PA1422472OtherHIGHMARK BLUE SHIELD
PA298755OtherMAMSI-WMG
PA1511872OtherGATEWAY-WMG
PA20018068OtherAMERIHEALTH MERCY-WMG
MD619020OtherCAREFIRST MD BCBS
MD619020OtherCAREFIRST MD BCBS
PA1511872OtherGATEWAY-WMG
PA460003776Medicare PIN