MEDICARE: DR. LEWIS M. FREDANE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD038589E	PA

General Provider Information

NPI Number	:	1558523092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS M. FREDANE MD

Provider Business Mailing Address
First Line	:	1815 JOHN F KENNEDY BLVD
Second Line	:	#2812
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1731
Country	:	US
Telephone Number	:	215-563-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 JOHN F KENNEDY BLVD
Second Line	:	#2812
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1731
Country	:	US
Telephone Number	:	215-563-4449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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