Healthcare Provider Details

I. General information

NPI: 1821275371
Provider Name (Legal Business Name): PHILIP L FREYTAG IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SMITH ROAD NHCNE NEWPORT
NEWPORT RI
02841-1002
US

IV. Provider business mailing address

9228 MEDICAL PLAZA DR
CHARLESTON SC
29406-9125
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-6068
  • Fax:
Mailing address:
  • Phone: 843-574-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: