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General NPI Number Information
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NPI Number | 1134126840
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Entity Type | Individual
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Provider Name | GORDON W FRIED D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 200 PLAZA CT SUITE C
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-8259
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Country | US
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Telephone | 570-424-9952
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Fax | 570-424-0768
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Provider Business Mailing Address
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Address Line | 200 PLAZA CT SUITE C
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-8259
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Country | US
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Telephone | 570-424-5592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OS-007213-E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | OS007213E
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License Number State | PA
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