Healthcare Provider Details

I. General information

NPI: 1710989751
Provider Name (Legal Business Name): ROBERT T FRIED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST STE 210
ASHLAND KY
41101-2868
US

IV. Provider business mailing address

200 PRINCESS DR
ASHLAND KY
41101-2190
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-9847
  • Fax: 606-324-3418
Mailing address:
  • Phone: 606-922-3103
  • Fax: 606-922-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35.122826
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number37173
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: