Provider Demographics
NPI:1427285915
Name:FREIFELD, MARTIN LEON (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LEON
Last Name:FREIFELD
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 1:32 SHRINE VW
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9213
Mailing Address - Country:US
Mailing Address - Phone:570-288-4800
Mailing Address - Fax:
Practice Address - Street 1:32 SHRINE VW
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9213
Practice Address - Country:US
Practice Address - Phone:570-288-4800
Practice Address - Fax:844-292-5725
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038850L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39606790019OtherME #
PA232480775OtherEIN
PA232480775OtherEIN