Provider Demographics
NPI:1194702407
Name:FREY, MARTHA L (PAC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:L
Last Name:FREY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:701 5TH ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1964
Practice Address - Country:US
Practice Address - Phone:724-774-5255
Practice Address - Fax:724-774-5686
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07816721Medicaid
064201Medicare ID - Type Unspecified
PA07816721Medicaid