Provider Demographics
NPI:1477500718
Name:FREITAS, LAWRENCE K (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:K
Last Name:FREITAS
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 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1332
Mailing Address - Country:US
Mailing Address - Phone:215-657-2012
Mailing Address - Fax:215-657-2018
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1332
Practice Address - Country:US
Practice Address - Phone:215-657-2012
Practice Address - Fax:215-657-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224133207R00000X
PAMD431120207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02334MD431120OtherHEALTH PARTNERS
PA1019298740001Medicaid
PA001974706OtherHIGHMARK BLUE SHIELD
PAMD431120OtherMEDICAL LICENSE
0048674000OtherIBC
PA7706849OtherAETNA PROVIDER NUMBER
P00435581OtherRAILROAD MEDICARE
231952978OtherTIN
231952978OtherTIN
PA112375FAGMedicare PIN