MEDICARE: THOMAS B FREY PAC

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	363A00000X	Physician Assistant	MA051864	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00652648	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50121162	OTHER	PA	CAPITAL BLUE CROSS
2	50054853	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1639130503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS B FREY PAC

Provider Business Mailing Address
First Line	:	431 W LINCOLN AVE
Second Line	:
City	:	MYERSTOWN
State	:	PA
Zip	:	17067-2328
Country	:	US
Telephone Number	:	717-866-5755
Fax Number	:	717-866-7120

Provider Business Practice Location Address
First Line	:	431 W LINCOLN AVE
Second Line	:
City	:	MYERSTOWN
State	:	PA
Zip	:	17067-2328
Country	:	US
Telephone Number	:	717-866-5755
Fax Number	:	717-866-7120

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	01/20/2014

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Directions to “ THOMAS B FREY PAC” Practice Location

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