MEDICARE: WILDCAT NEUROPHYSIOLOGY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	204R00000X	Electrodiagnostic Medicine Physician
3	2084N0400X	Neurology Physician
4	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1073026993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDCAT NEUROPHYSIOLOGY, PC

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E STE 105-484
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1339
Country	:	US
Telephone Number	:	484-351-8459
Fax Number	:	484-351-8810

Provider Business Practice Location Address
First Line	:	100 FRONT ST STE 280
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2891
Country	:	US
Telephone Number	:	484-351-8459
Fax Number	:	484-351-8810

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN FRIED
Credential	:	MD
Telephone Number	:	484-351-8459

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	12/08/2025

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