MEDICARE: DR. GAY L FRIED MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD441084	PA
2	208600000X	Surgery Physician	MD441084	PA
3	2086S0129X	Vascular Surgery Physician	MD441084	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1144218579	OTHER	PA	INDIVIDUAL NPI
2	199957ZAAQ	OTHER	PA	GROUP MEMBER PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144218579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAY L FRIED MD

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD
Second Line	:	SUITE 300
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1069
Country	:	US
Telephone Number	:	630-725-2730
Fax Number	:	844-205-5691

Provider Business Practice Location Address
First Line	:	6 NESHAMINY INTERPLEX
Second Line	:	113
City	:	TREVOSE
State	:	PA
Zip	:	19053-6964
Country	:	US
Telephone Number	:	215-245-1260
Fax Number	:	215-245-1560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	04/11/2017

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