Healthcare Provider Details

I. General information

NPI: 1861480576
Provider Name (Legal Business Name): WILLIAM N FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 02/16/2020
Certification Date: 02/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GOOSE LN
GUILFORD CT
06437-5101
US

IV. Provider business mailing address

21 LOVERS LN
MADISON CT
06443-3317
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-7200
  • Fax:
Mailing address:
  • Phone: 203-494-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number030954
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: