Healthcare Provider Details

I. General information

NPI: 1578910261
Provider Name (Legal Business Name): NICHOLAS ALAN FREIDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 200
AUSTIN TX
78705-1010
US

IV. Provider business mailing address

8240 N MOPAC EXPY STE 100
AUSTIN TX
78759-8869
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-5905
  • Fax: 512-477-8640
Mailing address:
  • Phone: 512-687-1970
  • Fax: 512-407-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberTP250
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberT4749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: