Healthcare Provider Details

I. General information

NPI: 1134126840
Provider Name (Legal Business Name): GORDON W FRIED D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PLAZA CT SUITE C
EAST STROUDSBURG PA
18301-8259
US

IV. Provider business mailing address

200 PLAZA CT SUITE C
EAST STROUDSBURG PA
18301-8259
US

V. Phone/Fax

Practice location:
  • Phone: 570-424-9952
  • Fax: 570-424-0768
Mailing address:
  • Phone: 570-424-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS-007213-E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS007213E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: