Provider Demographics
NPI:1023230455
Name:DONALD L FREIDENBERG
Entity type:Organization
Organization Name:DONALD L FREIDENBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREIDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-457-3100
Mailing Address - Street 1:2121 BETHEL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1804
Mailing Address - Country:US
Mailing Address - Phone:614-457-3100
Mailing Address - Fax:614-457-3200
Practice Address - Street 1:2121 BETHEL RD
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1804
Practice Address - Country:US
Practice Address - Phone:614-457-3100
Practice Address - Fax:614-457-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340031892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2921940Medicaid
OH9335951Medicare PIN
OH0586969Medicaid