Healthcare Provider Details

I. General information

NPI: 1134481047
Provider Name (Legal Business Name): FRED FRIDMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE
PORTLAND ME
04102-2363
US

IV. Provider business mailing address

136 LINDEN DR STE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-4000
  • Fax:
Mailing address:
  • Phone: 540-504-0118
  • Fax: 207-888-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18858
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO2594
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS20698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: