Basic Information
| Provider Information | |||||||||
| NPI: | 1013095330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIED | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14883 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366440111 | ||||||||
| FaxNumber: | 3366440085 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 NC HIGHWAY 68 N | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273109733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366440111 | ||||||||
| FaxNumber: | 3366440085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25798 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 22381 | 01 | NC | PARTNERS MEDICARE | OTHER | 77008 | 01 | NC | MEDCOST | OTHER | 891111N | 05 | NC | MEDICAID | 1111N | 01 | NC | BCBS OF NC | OTHER |