Provider Demographics
NPI:1427129840
Name:FRIDKIN, MARJORIE SUE (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:SUE
Last Name:FRIDKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 4TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1395
Mailing Address - Country:US
Mailing Address - Phone:301-334-1751
Mailing Address - Fax:301-334-3350
Practice Address - Street 1:255 NORTH 4TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1395
Practice Address - Country:US
Practice Address - Phone:301-334-8282
Practice Address - Fax:301-334-8468
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063141208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2146086OtherOPTIMUM CHOICE
MD2146086OtherALLIANCE
MD2146086OtherMAMSI
MD2146086OtherMD IPA
MD2146086OtherOPTIMUM CHOICE
MD2146086OtherMAMSI