Provider Demographics
NPI:1881627289
Name:SAMUEL D. FRIEDEL, M.D., LLC
Entity type:Organization
Organization Name:SAMUEL D. FRIEDEL, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FRIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-882-0620
Mailing Address - Street 1:8100 HARFORD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5703
Mailing Address - Country:US
Mailing Address - Phone:410-882-0620
Mailing Address - Fax:410-668-5075
Practice Address - Street 1:8100 HARFORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-5703
Practice Address - Country:US
Practice Address - Phone:410-882-0620
Practice Address - Fax:410-668-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020950207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70140Medicare UPIN
007NMedicare PIN