Healthcare Provider Details

I. General information

NPI: 1982622775
Provider Name (Legal Business Name): CHARLES K FRIEDMAN DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5767 49TH ST N
ST PETERSBURG FL
33709-2106
US

IV. Provider business mailing address

PO BOX 865756
ORLANDO FL
32886-5756
US

V. Phone/Fax

Practice location:
  • Phone: 727-350-0450
  • Fax: 727-350-0451
Mailing address:
  • Phone: 844-653-8300
  • Fax: 817-886-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: TRACIE GARI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 813-549-2134