Provider Demographics
NPI:1831237007
Name:FRIEDMAN, ROGER S (PHD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:S
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 GEORGIA AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3437
Mailing Address - Country:US
Mailing Address - Phone:301-588-4442
Mailing Address - Fax:301-588-4041
Practice Address - Street 1:8601 GEORGIA AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3437
Practice Address - Country:US
Practice Address - Phone:301-588-4442
Practice Address - Fax:301-588-4041
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401787Medicare ID - Type UnspecifiedPSYCHOLOGIST