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General NPI Number Information
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NPI Number | 1013988740
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Entity Type | Organization
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Legal Business Name | GLENN FREED DO PC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 100 SCHUYLKILL MEDICAL PLZ SUITE 101
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City | POTTSVILLE
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State | PA
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Zip | 17901-3663
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Country | US
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Telephone | 570-622-3366
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Fax | 570-622-6638
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Provider Business Mailing Address
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Address Line | 100 SCHUYLKILL MEDICAL PLZ SUITE 101
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City | POTTSVILLE
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State | PA
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Zip | 17901-3663
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Country | US
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Telephone | 570-622-3366
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Fax | 570-622-6638
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Authorized Official
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Title or Position | OWNER
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Name | GLENN FREED
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Credential | DO
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Telephone | 570-622-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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