Provider Demographics
NPI:1811944416
Name:TERRY F. KRIEDMAN, MD
Entity type:Organization
Organization Name:TERRY F. KRIEDMAN, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-696-9946
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-1380
Mailing Address - Country:US
Mailing Address - Phone:508-696-9946
Mailing Address - Fax:508-696-7155
Practice Address - Street 1:455 STATE ROAD
Practice Address - Street 2:WOODLAND CENTER
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02658-7625
Practice Address - Country:US
Practice Address - Phone:508-696-9946
Practice Address - Fax:508-696-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAV95OtherHARVARD PILGRIM
MAM17365OtherBLUE CROSS/BLUE SHIELD
MAM21243Medicare PIN