Provider Demographics
NPI:1104983600
Name:FRIEDMAN, GARY (MS)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ABERDEEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0635
Mailing Address - Country:US
Mailing Address - Phone:704-868-8400
Mailing Address - Fax:704-868-8493
Practice Address - Street 1:1180 WYKE RD.
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-487-9100
Practice Address - Fax:704-487-5230
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7218207Y00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology