Basic Information
Provider Information
NPI: 1598086407
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEDMAN
FirstName: BETH
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 555 N DUKE ST
Address2:  
City: LANCASTER
State: PA
PostalCode: 176022250
CountryCode: US
TelephoneNumber: 7175444950
FaxNumber: 7175445964
Practice Location
Address1: 555 N DUKE ST
Address2:  
City: LANCASTER
State: PA
PostalCode: 17602
CountryCode: US
TelephoneNumber: 7175444950
FaxNumber: 7175445964
Other Information
ProviderEnumerationDate: 06/15/2010
LastUpdateDate: 06/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD448266PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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