Provider Demographics
NPI:1063492601
Name:FREIDENBERG, DONALD LORRY (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LORRY
Last Name:FREIDENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 BETHEL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1804
Mailing Address - Country:US
Mailing Address - Phone:614-457-3100
Mailing Address - Fax:614-457-3200
Practice Address - Street 1:2121 BETHEL RD
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1804
Practice Address - Country:US
Practice Address - Phone:614-457-3100
Practice Address - Fax:614-457-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340031892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0586969Medicaid
OH0586969Medicaid