MEDICARE: JUDI GAIL FRIEDMAN PA-C

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	363AM0700X	Medical Physician Assistant	16926	CA
2	363AM0700X	Medical Physician Assistant	0010-01258	NC
3	363AM0700X	Medical Physician Assistant	9105084	FL
4	363A00000X	Physician Assistant	0550031019	VT
5	363AM0700X	Medical Physician Assistant	0550031019	VT

General Provider Information

NPI Number	:	1295808061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDI GAIL FRIEDMAN PA-C

Provider Business Mailing Address
First Line	:	289 COUNTY RD
Second Line	:
City	:	WINDSOR
State	:	VT
Zip	:	05089-9000
Country	:	US
Telephone Number	:	802-674-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 PLEASANT ST
Second Line	:	OTTAUQUECHEE HEALTH CENTER
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-1122
Country	:	US
Telephone Number	:	802-457-3030
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	02/04/2010

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