Healthcare Provider Details

I. General information

NPI: 1558596452
Provider Name (Legal Business Name): MONICA LAUREN FRIEDMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MONICA LAUREN MARCUS

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W GORE ST
ORLANDO FL
32806-1141
US

IV. Provider business mailing address

60 W GORE ST
ORLANDO FL
32806-1141
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5252
  • Fax: 352-294-5248
Mailing address:
  • Phone: 352-294-5252
  • Fax: 352-294-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberUO2076
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberQ6229
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number265826
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberOS11697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: