Provider Demographics
NPI:1851384671
Name:FRIED, PETER R (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:FRIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:#105
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-860-2692
Practice Address - Fax:513-860-1614
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350567212085R0001X
KY259982085R0001X
IN01053774A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100373300Medicaid
KY64861271Medicaid
OH0706294Medicaid
KY64861271Medicaid
A83217Medicare UPIN
IN100373300Medicaid
OH0706294Medicaid
IN176760LMedicare PIN