Provider Demographics
NPI:1750356770
Name:FRIEND, CLARENCE W JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:W
Last Name:FRIEND
Suffix:JR
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 1:15425 WARWICK BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1579
Mailing Address - Country:US
Mailing Address - Phone:757-874-8400
Mailing Address - Fax:757-947-2001
Practice Address - Street 1:15425 WARWICK BLVD STE H
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-1579
Practice Address - Country:US
Practice Address - Phone:757-874-8400
Practice Address - Fax:757-947-2001
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005631297Medicaid
VA005631297Medicaid
VA080006511Medicare PIN