Healthcare Provider Details

I. General information

NPI: 1023019247
Provider Name (Legal Business Name): DAVID L FRIESWYK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD SUITE 1E50
NEWARK DE
19718-2200
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1980
  • Fax: 410-601-0901
Mailing address:
  • Phone: 410-601-0900
  • Fax: 410-601-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC01861
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: