Healthcare Provider Details

I. General information

NPI: 1811944416
Provider Name (Legal Business Name): TERRY F. KRIEDMAN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 STATE ROAD WOODLAND CENTER
VINEYARD HAVEN MA
02658-7625
US

IV. Provider business mailing address

PO BOX 1380
WEST TISBURY MA
02575-1380
US

V. Phone/Fax

Practice location:
  • Phone: 508-696-9946
  • Fax: 508-696-7155
Mailing address:
  • Phone: 508-696-9946
  • Fax: 508-696-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY F KRIEDMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-696-9946