Provider Demographics
NPI:1740260371
Name:FRIEDMAN, MARTIN LOUIS (DO)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:LOUIS
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DO
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 782743
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2743
Mailing Address - Country:US
Mailing Address - Phone:602-910-6887
Mailing Address - Fax:215-612-5077
Practice Address - Street 1:4900 FRANKFORD AVE
Practice Address - Street 2:ATTN: RADIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2618
Practice Address - Country:US
Practice Address - Phone:215-612-2610
Practice Address - Fax:215-612-5077
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003194L2085R0202X, 2085N0904X, 207U00000X
NJ25MB034008002085R0202X, 2085N0904X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine