Provider Demographics
NPI:1821197450
Name:FREEDMAN, LOUIS JAY (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JAY
Last Name:FREEDMAN
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:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0828
Mailing Address - Country:US
Mailing Address - Phone:570-288-4566
Mailing Address - Fax:570-270-5151
Practice Address - Street 1:VALLEY MEDICAL BUILDING, 3RD FLOOR
Practice Address - Street 2:1010 EAST MOUNTAIN BOULEVARD
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711
Practice Address - Country:US
Practice Address - Phone:570-288-4566
Practice Address - Fax:570-270-5151
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016977E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C27880Medicare UPIN
027819FAVMedicare PIN