Provider Demographics
NPI:1922103639
Name:FREEDBERG, LAWRENCE E (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:FREEDBERG
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 1:600 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1426
Mailing Address - Country:US
Mailing Address - Phone:724-539-9736
Mailing Address - Fax:724-539-2836
Practice Address - Street 1:600 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1426
Practice Address - Country:US
Practice Address - Phone:724-539-9736
Practice Address - Fax:724-539-2836
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017654E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0638412Medicaid
PA300589OtherUPMC
1002238OtherGATEWAY
PA088162OtherHIGHMARK BLUE SHIELD
PA0638412Medicaid
1002238OtherGATEWAY