Provider Demographics
NPI:1881626059
Name:FRIED, ROY (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:FRIED
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 1:7758 WISCONSIN AVE
Mailing Address - Street 2:# 211
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3530
Mailing Address - Country:US
Mailing Address - Phone:301-530-3237
Mailing Address - Fax:301-907-4590
Practice Address - Street 1:6935 WISCONSIN AVE STE 314
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6112
Practice Address - Country:US
Practice Address - Phone:301-530-3237
Practice Address - Fax:301-907-4590
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00034590207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415096100Medicaid
MD400550300Medicaid
MD110214588Medicare PIN
E34823Medicare UPIN
MD400550300Medicaid
MD415096100Medicaid