Healthcare Provider Details

I. General information

NPI: 1679545867
Provider Name (Legal Business Name): GREGORY H FREITAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 06/11/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BHC WASHINGTON NAVY YARD 915 N STREET SE
WASHINGTON DC
20374
US

IV. Provider business mailing address

3259 CATLIN AVE
QUANTICO VA
22134
US

V. Phone/Fax

Practice location:
  • Phone: 202-433-3294
  • Fax:
Mailing address:
  • Phone: 703-784-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101235613
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: