Healthcare Provider Details

I. General information

NPI: 1497922587
Provider Name (Legal Business Name): L. KALEB FRIEND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAUREN R FRIEND

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-7215
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4063
  • Fax:
Mailing address:
  • Phone: 202-476-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA105460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: