Individual provider Active NPI

Lawrence Elliot Fried, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Philadelphia, PA
National Provider Identifier
1417246760
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
MD460835 Issued in PA
Practice address
3500 Civic Center Blvd
Philadelphia, PA 19104-4395
Phone
(215) 590-1000
Fax
(215) 590-1771
NPI assigned
Apr 6, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD460835 PA
Epilepsy Physician 2084E0001X MD460835 PA
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X MD460835 PA Primary

Addresses

Primary practice location

3500 Civic Center Blvd
Philadelphia, PA 19104-4395

Mailing address

100 Penn Square East
9TH Floor North Tower
Philadelphia, PA 19107
Phone (267) 425-9200

Other practice location 1

3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone (215) 590-1719

Other identifiers 1

IdentifierTypeStateIssuer
1033085850001MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.chop.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170804001651 PA Practitioner - Neurology 2668743972 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD460835PAMDEpilepsy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childrens Health Care Associates, Inc Pediatrics CurrentSince Jun 7, 2017 Accepting new patients
Childen'S Health Care Associates Inc. CurrentSince Jun 7, 2017 Accepting new patients
Children'S Surgical Associates LTD Past Accepting new patients
Childrens Health Care Associates of New Jersey PC Pediatrics Past Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1417246760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PENN SQUARE EAST",
            "address_2": "9TH FLOOR NORTH TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "267-425-9200",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044395",
            "telephone_number": "215-590-1000",
            "fax_number": "215-590-1771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 Civic Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044319",
            "country_code": "US",
            "telephone_number": "215-590-1719",
            "fax_number": "215-590-1771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRIED",
        "first_name": "LAWRENCE",
        "middle_name": "ELLIOT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-06",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD460835",
            "primary": false
        },
        {
            "code": "2084E0001X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Epilepsy",
            "state": "PA",
            "license": "MD460835",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "PA",
            "license": "MD460835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033085850001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.chop.edu",
            "affiliation": "N",
            "endpointDescription": "CHOP",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3401 Civic Center Blvd",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191044319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.