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General NPI Number Information
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NPI Number | 1417932013
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Entity Type | Individual
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Provider Name | MARTHA FRIBERG D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 43 BAXTER BLVD
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City | PORTLAND
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State | ME
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Zip | 04101-1823
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Country | US
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Telephone | 207-775-6381
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Fax | 207-775-3378
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Provider Business Mailing Address
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Address Line | 43 BAXTER BLVD
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City | PORTLAND
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State | ME
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Zip | 04101-1823
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Country | US
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Telephone | 207-775-6381
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Fax | 207-775-3378
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 962
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License Number State | ME
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