Provider Demographics
NPI:1972618593
Name:FRIED, SUZANNE R (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:R
Last Name:FRIED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 ISHLER ST
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1222
Mailing Address - Country:US
Mailing Address - Phone:814-466-7025
Mailing Address - Fax:
Practice Address - Street 1:826 ISHLER ST
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1222
Practice Address - Country:US
Practice Address - Phone:814-466-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG129422084P0800X
NY0963032084P0800X
PA033124E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry