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General NPI Number Information
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NPI Number | 1336116797
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Entity Type | Individual
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Provider Name | MARK DOUGLAS FREY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 6119 US HIGHWAY 11
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City | CANTON
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State | NY
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Zip | 13617-3991
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Country | US
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Telephone | 315-261-5850
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LEROY ST
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City | POTSDAM
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State | NY
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Zip | 13676-1786
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Country | US
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Telephone | 315-265-3300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 21783
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 330710
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 330710
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License Number State | NY
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