Basic Information
Provider Information
NPI: 1588748289
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRIEDMAN
FirstName: STEPHEN
MiddleName: WILLIAM
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2511 OLD CORNWALLIS RD
Address2: SUITE 200
City: DURHAM
State: NC
PostalCode: 277131869
CountryCode: US
TelephoneNumber: 9199325700
FaxNumber: 9199336881
Practice Location
Address1: 2511 OLD CORNWALLIS RD
Address2: SUITE 200
City: DURHAM
State: NC
PostalCode: 277131869
CountryCode: US
TelephoneNumber: 9199325700
FaxNumber: 9199336881
Other Information
ProviderEnumerationDate: 10/25/2006
LastUpdateDate: 09/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X00-18768NCN Allopathic & Osteopathic PhysiciansFamily Medicine 
207RG0300X18768NCY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

No ID Information.


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