Amy L Friedenthal Md Pc | |
12512 Lake Ridge Dr Ste D Lake Ridge VA 22192-2386 | |
(703) 497-5555 | |
(703) 497-1479 |
Full Name | Amy L Friedenthal Md Pc |
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Speciality | Internal Medicine |
Location | 12512 Lake Ridge Dr Ste D, Lake Ridge, Virginia |
Authorized Official Name and Position | Amy Friedenthal (PHYSICIAN) |
Authorized Official Contact | 7034975555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Amy L Friedenthal Md Pc 12512 Lake Ridge Dr Ste D Lake Ridge VA 22192-2386 Ph: (703) 497-5555 | Amy L Friedenthal Md Pc 12512 Lake Ridge Dr Ste D Lake Ridge VA 22192-2386 Ph: (703) 497-5555 |
NPI Number | 1174722664 |
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Provider Enumeration Date | 07/13/2007 |
Last Update Date | 07/13/2007 |
Medicare PECOS PAC ID | 2365344934 |
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Medicare Enrollment ID | O20040123000446 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174722664 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Amy Friedenthal |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1427176999 PECOS PAC ID: 5395647960 Enrollment ID: I20040123000611 |
Primary Gerontology Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4196 Merchant Plz Ste 348, Lake Ridge, VA 22192 Phone: 571-206-1650 | |