Provider Demographics
NPI:1194054171
Name:FRIED AND WILKS, LLC
Entity type:Organization
Organization Name:FRIED AND WILKS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-530-3237
Mailing Address - Street 1:6935 WISCONSIN AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6112
Mailing Address - Country:US
Mailing Address - Phone:301-530-3237
Mailing Address - Fax:301-907-4590
Practice Address - Street 1:6935 WISCONSIN AVE STE 314
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6112
Practice Address - Country:US
Practice Address - Phone:301-530-3237
Practice Address - Fax:301-907-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34590207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E34823Medicare UPIN
F97226Medicare UPIN