MEDICARE: WALTER JONATHAN FRIEDLEY 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	208000000X	Pediatrics Physician	35.079367	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	370018677	OTHER		TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	311098079	OTHER	TAX ID
3	1202702	OTHER	UHC
4	7052274	OTHER	AETNA
5	353077	OTHER	SUBMITTER NO
6	000000202163	OTHER	ANTHEM
7	311090079	OTHER	CIGNA

General Provider Information

NPI Number	:	1518925072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER JONATHAN FRIEDLEY MD

Provider Business Mailing Address
First Line	:	L-3549
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43260-0001
Country	:	US
Telephone Number	:	740-383-7927
Fax Number	:	740-383-7942

Provider Business Practice Location Address
First Line	:	1040 DELAWARE AVENEUE
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43301-1814
Country	:	US
Telephone Number	:	740-383-8090
Fax Number	:	740-375-6481

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	12/21/2021

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Directions to “ WALTER JONATHAN FRIEDLEY MD” Practice Location

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