Provider Demographics
NPI:1407211808
Name:FREEBURG, DOMINIC DAMIAN (PA-S)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:DAMIAN
Last Name:FREEBURG
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S 44TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2936
Mailing Address - Country:US
Mailing Address - Phone:712-389-2418
Mailing Address - Fax:
Practice Address - Street 1:227 S 44TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2936
Practice Address - Country:US
Practice Address - Phone:712-389-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program