Provider Demographics
NPI:1396842696
Name:FREAS, CAROL D (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:D
Last Name:FREAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:5TH FLOOR BAHAVIORAL MEDICINE
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-347-1300
Mailing Address - Fax:304-347-1397
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:5TH FLOOR BAHAVIORAL MEDICINE
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-347-1300
Practice Address - Fax:304-347-1397
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV162492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042944000Medicaid
WVFR0678012Medicare ID - Type Unspecified
WV0042944000Medicaid