Provider Demographics
NPI:1447203138
Name:HIMMELSTEIN, FRED RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:RAYMOND
Last Name:HIMMELSTEIN
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 1:203 BARN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2334
Mailing Address - Country:US
Mailing Address - Phone:610-429-9702
Mailing Address - Fax:
Practice Address - Street 1:1015 W BALTIMORE PIKE
Practice Address - Street 2:JENNERSVILLE REGIONAL HOSPITAL
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9499
Practice Address - Country:US
Practice Address - Phone:610-869-1000
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024348E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000949860Medicaid
PA000949860Medicaid
PA131997Medicare ID - Type Unspecified