Provider Demographics
NPI:1437308970
Name:FREDA, ANGELO JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:JOSEPH
Last Name:FREDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 N KEYS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-8123
Mailing Address - Country:US
Mailing Address - Phone:301-503-0424
Mailing Address - Fax:
Practice Address - Street 1:12304 N KEYS RD
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8123
Practice Address - Country:US
Practice Address - Phone:301-503-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052419207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics