Provider Demographics
NPI:1356411201
Name:FRIEDEN, TARA
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:FRIEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 WADING CRANE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055
Mailing Address - Country:US
Mailing Address - Phone:317-501-5868
Mailing Address - Fax:317-336-5061
Practice Address - Street 1:9912 WADING CRANE AVENUE
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055
Practice Address - Country:US
Practice Address - Phone:317-501-5868
Practice Address - Fax:317-336-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist