Provider Demographics
NPI:1831127091
Name:FREEMAN, JEFFREY S (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DO
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 1533
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-0440
Mailing Address - Country:US
Mailing Address - Phone:215-871-1916
Mailing Address - Fax:215-871-1928
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:SUITE 324
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-1916
Practice Address - Fax:215-871-1928
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004328L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010027617OtherRAILROAD MEDICARE
PA0090850903OtherAMERICHOICE
PA33607OtherKEYSTONE MERCY
PA2Y3246OtherELDER CARE
PA01943OtherHEALTH PARTNERS
PA083037OtherHIGHMARK BLUE SHIELD
PA0009085090004Medicaid
PA277162OtherAETNA
PA0054103000OtherINDEPENDENCE BLUE CROSS
PA083037Medicare ID - Type Unspecified
PA33607OtherKEYSTONE MERCY