Healthcare Provider Details

I. General information

NPI: 1417953886
Provider Name (Legal Business Name): IDO FRIEDMAN D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126B HIGHWAY 81 N
ANDERSON SC
29621-1532
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 864-231-6395
  • Fax:
Mailing address:
  • Phone: 864-231-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number847
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number524
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: