Healthcare Provider Details

I. General information

NPI: 1962608125
Provider Name (Legal Business Name): HOLLY JANEL FREED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY JANEL RITCHIE

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 209
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

PO BOX 609
ELIZABETH WV
26143-0609
US

V. Phone/Fax

Practice location:
  • Phone: 740-236-9088
  • Fax: 740-236-9089
Mailing address:
  • Phone: 304-275-3301
  • Fax: 304-275-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number22476
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35130581
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: