Basic Information
| Provider Information | |||||||||
| NPI: | 1386681948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEDMAN | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | KIRK | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
| FaxNumber: | 2674791321 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 TILLMAN DR FL 2 | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190202071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673393558 | ||||||||
| FaxNumber: | 2673393763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 307199 | NY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | 25MB050201800 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | OS005070L | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0053469 | 01 | PA | AETNA | OTHER | 0032628000 | 01 | PA | IBC | OTHER | 127775 | 01 | CIGNA | OTHER |