Healthcare Provider Details

I. General information

NPI: 1891243069
Provider Name (Legal Business Name): ELIZABETH KATLYN FREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR
ARLINGTON VA
22205-3683
US

IV. Provider business mailing address

2550 17TH ST NW APT 416
WASHINGTON DC
20009-3096
US

V. Phone/Fax

Practice location:
  • Phone: 703-842-4188
  • Fax:
Mailing address:
  • Phone: 678-910-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-005488
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110005488
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: