Provider Demographics
NPI: | 1174644306 |
---|---|
Name: | FREEMAN, DANIEL MOSHE AVROM (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DANIEL |
Middle Name: | MOSHE AVROM |
Last Name: | FREEMAN |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 721 UPSAL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | JENKINTOWN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19046-3329 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-884-3568 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 721 UPSAL RD |
Practice Address - Street 2: | |
Practice Address - City: | JENKINTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19046-3329 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-884-3568 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-04-03 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD014094E | 103TP0814X, 2084P0800X, 2084P0804X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis |
Not Answered | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Not Answered | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |