Healthcare Provider Details

I. General information

NPI: 1336100643
Provider Name (Legal Business Name): FREEPORT MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MARKET ST
FREEPORT PA
16229-1121
US

IV. Provider business mailing address

419 MARKET ST
FREEPORT PA
16229-1121
US

V. Phone/Fax

Practice location:
  • Phone: 724-295-5202
  • Fax: 724-295-1160
Mailing address:
  • Phone: 724-295-5202
  • Fax: 724-295-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD014710Y
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD014710Y
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD014950Y
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier732119
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD
# 2
Identifier0006560450001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: SAKDIDEJ SUWAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 724-295-5202