Provider Demographics
NPI:1982622775
Name:CHARLES K FRIEDMAN DO PA
Entity Type:Organization
Organization Name:CHARLES K FRIEDMAN DO PA
Other - Org Name:PAIN RELIEF CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-350-0450
Mailing Address - Street 1:PO BOX 865756
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-5756
Mailing Address - Country:US
Mailing Address - Phone:844-653-8300
Mailing Address - Fax:817-886-3647
Practice Address - Street 1:5767 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2106
Practice Address - Country:US
Practice Address - Phone:727-350-0450
Practice Address - Fax:727-350-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3364Medicare ID - Type UnspecifiedGROUP MEDICARE ID