=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750559308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHEAL FRIEDMAN ND
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2008
-----------------------------------------------------
Last Update Date | 02/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146 MAIN ST UNIT 6
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-2920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-262-6011
-----------------------------------------------------
Fax | 916-404-6798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 MAIN ST UNIT 6
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-2920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-262-6011
-----------------------------------------------------
Fax | 916-404-6798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 099-0000165
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------