Healthcare Provider Details

I. General information

NPI: 1437155850
Provider Name (Legal Business Name): MATTHEW FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SULLIVAN AVE STE B1
SOUTH WINDSOR CT
06074-2000
US

IV. Provider business mailing address

1050 SULLIVAN AVE STE B1
SOUTH WINDSOR CT
06074-2000
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-3411
  • Fax: 860-644-3346
Mailing address:
  • Phone: 860-644-3411
  • Fax: 860-644-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number029446
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: