Provider Demographics
NPI:1144218579
Name:FRIED, GAY L (MD)
Entity type:Individual
Prefix:DR
First Name:GAY
Middle Name:L
Last Name:FRIED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1069
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:6 NESHAMINY INTERPLEX
Practice Address - Street 2:113
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6964
Practice Address - Country:US
Practice Address - Phone:215-245-1260
Practice Address - Fax:215-245-1560
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD441084207V00000X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1144218579OtherINDIVIDUAL NPI
PA199957ZAAQOtherGROUP MEMBER PTAN
NJ8547700Medicaid
PA183135879Medicare PIN
PA194873Medicare PIN
NJE86108Medicare UPIN
PA199957ZAAQOtherGROUP MEMBER PTAN
PAP00899963Medicare PIN
NJ8547700Medicaid
PA195557YCYYMedicare PIN