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General NPI Number Information
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NPI Number | 1821275371
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Entity Type | Individual
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Provider Name | PHILIP L FREYTAG IDC
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Gender | Male
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 43 SMITH ROAD NHCNE NEWPORT
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City | NEWPORT
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State | RI
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Zip | 02841-1002
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Country | US
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Telephone | 401-841-6068
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Fax |
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Provider Business Mailing Address
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Address Line | 9228 MEDICAL PLAZA DR
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City | CHARLESTON
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State | SC
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Zip | 29406-9125
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Country | US
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Telephone | 843-574-5693
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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