Provider Demographics
NPI:1164413126
Name:FREEMAN, SCOTT GARTH (SCOTT FREEMAN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:GARTH
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:SCOTT FREEMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8896 CLEARWATER CIR
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-2046
Mailing Address - Country:US
Mailing Address - Phone:610-285-4245
Mailing Address - Fax:
Practice Address - Street 1:8896 CLEARWATER CIR
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-2046
Practice Address - Country:US
Practice Address - Phone:610-285-4245
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA098818146N00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician