Provider Demographics
NPI:1780677328
Name:FREYTAG, THOMAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:FREYTAG
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 1:601 WARREN ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1106
Mailing Address - Country:US
Mailing Address - Phone:419-738-6556
Mailing Address - Fax:419-738-8758
Practice Address - Street 1:1251 LINCOLN HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9364
Practice Address - Country:US
Practice Address - Phone:419-738-5151
Practice Address - Fax:419-738-5200
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460979Medicaid
OHP00320372OtherRR MEDICARE
OH000000384983OtherANTHEM
OH06037OtherPARAMOUNT
OH735048OtherBUCKEYE
OHA79228Medicare UPIN
OH0460979Medicaid