Provider Demographics
NPI:1427176999
Name:FRIEDENTHAL, AMY LYN (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYN
Last Name:FRIEDENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125120 D LAKERIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-497-5555
Mailing Address - Fax:703-684-6311
Practice Address - Street 1:125120 D LAKERIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-497-5555
Practice Address - Fax:703-497-1479
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101047502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010031427Medicaid
VA0004666397OtherAETNA
VA267008OtherBLUE CROSS - ANTHEM
VA0004666397OtherAETNA
VAF66442Medicare UPIN