Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD042825E | PA |
N | 111NI0900X | Internist | MD042825E | PA |
Y | 207RN0300X | Nephrologist | MD042825E | PA |
NPI | 1053315549 |
---|---|
Provider Name | George J Frem |
First Address | Johnstown, PA 15905-4146 |
Second Address | Johnstown, PA 15905-4146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E45242 | (02) |