Basic Information
| Provider Information | |||||||||
| NPI: | 1285618850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREED | ||||||||
| FirstName: | NATHAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 E ALLEGHENY AVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191344427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269022 | ||||||||
| FaxNumber: | 2159263888 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 E ALLEGHENY AVE | ||||||||
| Address2: | MADEL PAVILION 1ST FL | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191344427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159363880 | ||||||||
| FaxNumber: | 2159263888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 01/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | OS006031E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 500525 | 01 | PA | COVENTRY HEALTH AMERICA | OTHER | 000868000 | 05 | PA | MEDICAID | 1644822 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30027706 | 01 | PA | KMHP | OTHER | 3Y5980 | 01 | PA | HEALTH NET | OTHER | 1238538 | 01 | PW | UNITED HEALTHCARE | OTHER | P00025016 | 01 | PA | RR MEDICARE | OTHER | 0003287701 | 01 | PA | AMERICHOICE | OTHER | 12844 | 01 | PA | BRAVO HEALTH | OTHER | 1029320 | 01 | PA | AETNA HMO | OTHER | 2319758000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 5808048 | 01 | PA | AETNA PPO | OTHER |