Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 25MB050201800 | NJ |
Y | 2081P2900X | Pain Medicine | OS005070L | PA |
NPI | 1386681948 |
---|---|
Provider Name | Mitchell Kirk Freedman |
First Address | Philadelphia, PA 19107-4216 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0032628000 | IBC (01) | PA |
0053469 | AETNA (01) | PA |
127775 | CIGNA (01) | |
C31014 | (02) |