Healthcare Provider Details

I. General information

NPI: 1851390280
Provider Name (Legal Business Name): TIMOTHY EDWARD FREI M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 ACADEMY ST S
AHOSKIE NC
27910-3200
US

IV. Provider business mailing address

312 ACADEMY ST S PO BOX 340
AHOSKIE NC
27910-3200
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-4155
  • Fax: 252-332-6527
Mailing address:
  • Phone: 252-332-4155
  • Fax: 252-332-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26000
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: