Healthcare Provider Details

I. General information

NPI: 1730138926
Provider Name (Legal Business Name): ROTEM FRIEDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOUTH 54TH STREET
PHILADELPHIA PA
19143-1900
US

IV. Provider business mailing address

DEPT 4931
CAROL STREAM IL
60122-4931
US

V. Phone/Fax

Practice location:
  • Phone: 215-748-9000
  • Fax:
Mailing address:
  • Phone: 866-540-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD421881
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: