Healthcare Provider Details

I. General information

NPI: 1407951346
Provider Name (Legal Business Name): KEVIN JACOB FRIEDMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CTR 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

11635 SW 135TH PL
MIAMI FL
33186-4429
US

V. Phone/Fax

Practice location:
  • Phone: 301-785-6077
  • Fax:
Mailing address:
  • Phone: 301-785-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102201906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: