Healthcare Provider Details

I. General information

NPI: 1922103639
Provider Name (Legal Business Name): LAWRENCE E FREEDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LIGONIER ST
LATROBE PA
15650-1426
US

IV. Provider business mailing address

600 LIGONIER ST
LATROBE PA
15650-1426
US

V. Phone/Fax

Practice location:
  • Phone: 724-539-9736
  • Fax: 724-539-2836
Mailing address:
  • Phone: 724-539-9736
  • Fax: 724-539-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD017654E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0638412
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier300589
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 3
Identifier1002238
Identifier TypeOTHER
Identifier State
Identifier IssuerGATEWAY
# 4
Identifier088162
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: