Healthcare Provider Details

I. General information

NPI: 1053675751
Provider Name (Legal Business Name): FREMONT EMERGENCY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE
FREMONT OH
43420-3237
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-7331
  • Fax:
Mailing address:
  • Phone: 856-686-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN G. HOLTZCLAW
Title or Position: OWNER
Credential: MD
Phone: 856-686-4317