Provider Demographics
NPI:1649254442
Name:FRIEDRICH, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:FRIEDRICH
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:PO BOX 79022
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271
Mailing Address - Country:US
Mailing Address - Phone:704-574-0471
Mailing Address - Fax:704-574-0471
Practice Address - Street 1:1423 E FRANKLIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5266
Practice Address - Country:US
Practice Address - Phone:704-574-0471
Practice Address - Fax:704-574-0471
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17471207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN28028Medicaid
NC8933935Medicaid
SCN28028Medicaid
NC8933935Medicaid
NCC83918Medicare UPIN
NC206446AMedicare PIN