Healthcare Provider Details

I. General information

NPI: 1497748800
Provider Name (Legal Business Name): DAVID G FREAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRANDERMILL BLVD SUITE 250
GAMBRILLS MD
21054-1690
US

IV. Provider business mailing address

PO BOX 64618
BALTIMORE MD
21264-4618
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-1507
  • Fax: 410-721-1510
Mailing address:
  • Phone: 443-481-6577
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD35601
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: