Basic Information
Provider Information | |||||||||
NPI: | 1356392633 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FRIEDMAN | ||||||||
FirstName: | BART | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7 ACEE DRIVE | ||||||||
Address2: |   | ||||||||
City: | NATRONA HEIGHTS | ||||||||
State: | PA | ||||||||
PostalCode: | 15065 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8002235544 | ||||||||
FaxNumber: | 7242943206 | ||||||||
Practice Location | |||||||||
Address1: | 1301 CARLISLE ST | ||||||||
Address2: | DEPT OF RADIOLOGY | ||||||||
City: | NATRONA HEIGHTS | ||||||||
State: | PA | ||||||||
PostalCode: | 15065 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7243344774 | ||||||||
FaxNumber: | 7243344776 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/12/2006 | ||||||||
LastUpdateDate: | 10/25/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD024978E | PA | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | MD024978E | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | MD024978E | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | MD024978E | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0204X | MD024978E | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | MD024978E | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
ID | Type | State | Issuer | Description | 0009247630008 | 05 | PA |   | MEDICAID | 198191 | 01 | PA | HIGHMARK | OTHER |