Provider Demographics
NPI:1528036407
Name:FREY, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:FREY
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 WARREN AVE STE 303
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2665
Practice Address - Country:US
Practice Address - Phone:570-326-8800
Practice Address - Fax:570-320-7849
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071122L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1998149OtherUNITEDHEALTHCARE
PA0018143270001Medicaid
PAH18105OtherHEALTHAMERICA
PA7421102OtherAETNA
PA817554OtherFIRST PRIORITY HEALTH
PA863096OtherHIGHMARK BLUE SHIELD
PA1998149OtherUNITEDHEALTHCARE
PAP00098026Medicare PIN
PA817554OtherFIRST PRIORITY HEALTH