Healthcare Provider Details

I. General information

NPI: 1750328308
Provider Name (Legal Business Name): RIDA ANIS FRAYHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 FORDS LN SUITE E
BALTIMORE MD
21215-2931
US

IV. Provider business mailing address

12 FOX KNOLL CT
TIMONIUM MD
21093-2848
US

V. Phone/Fax

Practice location:
  • Phone: 410-358-2741
  • Fax: 410-358-5184
Mailing address:
  • Phone: 410-358-2741
  • Fax: 410-358-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD21058
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: