Provider Demographics
NPI:1225367436
Name:PEDIATRIC CARDIOLOGY OF ERIE
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY OF ERIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-455-2252
Mailing Address - Street 1:1351 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2503
Mailing Address - Country:US
Mailing Address - Phone:814-455-2252
Mailing Address - Fax:814-455-1252
Practice Address - Street 1:1351 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2503
Practice Address - Country:US
Practice Address - Phone:814-455-2252
Practice Address - Fax:814-455-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060978L2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty