Provider Demographics
NPI:1487621728
Name:FRYE, GLADYS (MD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:FRYE
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:694 GOOD DR
Practice Address - Street 2:SUITE 11
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2433
Practice Address - Country:US
Practice Address - Phone:717-544-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057646L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000891378OtherHIGHMARK
PA50065912OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA0124457000OtherINDEPENDENCE BLUE CROSS
PA7660045OtherAETNA-NON HMO
PA000000209643OtherUNISON
PA000000209643OtherGATEWAY
PA001598026Medicaid
PA1509397OtherAETNA-HMO
PA20061140OtherMERCY
PA8107462OtherCIGNA
PA1509397OtherAETNA-HMO
PA20061140OtherMERCY