=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629255641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. SUSAN DOROTHY FREUNDEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2008
-----------------------------------------------------
Last Update Date | 01/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 STOCK STREET, SUITE 112
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-637-5131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 STOCK STREET, SUITE 112
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-637-5131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AX000767
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------