Provider Demographics
NPI:1104997584
Name:FRIED, MARVIN P (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:P
Last Name:FRIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 86TH ST
Mailing Address - Street 2:APT. 9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3139
Mailing Address - Country:US
Mailing Address - Phone:718-920-2991
Mailing Address - Fax:718-944-7207
Practice Address - Street 1:MMC - DEPT. OF OTOLARYNGOLOGY
Practice Address - Street 2:3400 BAINBRIDGE AVENUE, 3RD FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213558207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology