Basic Information
| Provider Information | |||||||||
| NPI: | 1144218579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIED | ||||||||
| FirstName: | GAY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 BUTTERFIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252730 | ||||||||
| FaxNumber: | 8442055691 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 NESHAMINY INTERPLEX | ||||||||
| Address2: | 113 | ||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152451260 | ||||||||
| FaxNumber: | 2152451560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD441084 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208600000X | MD441084 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD441084 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1144218579 | 01 | PA | INDIVIDUAL NPI | OTHER | 199957ZAAQ | 01 | PA | GROUP MEMBER PTAN | OTHER | 8547700 | 05 | NJ | MEDICAID |