Healthcare Provider Details

I. General information

NPI: 1205994530
Provider Name (Legal Business Name): AMBER MARIE FRIEDMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER MARIE WILSON P.A.

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 OLENTANGY RIVER RD
COLUMBUS OH
43212-3117
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-0066
  • Fax: 614-293-7264
Mailing address:
  • Phone: 614-293-0066
  • Fax: 614-293-7264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003419
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5845
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: