Provider Demographics
NPI:1972542538
Name:FREEMARK, TERRY (CRNA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:FREEMARK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:TOWER 3-SUITE 3006
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-7979
Mailing Address - Fax:215-456-8530
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:KORMAN-SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-254-2612
Practice Address - Fax:215-456-5926
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN208652L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA696607Medicare ID - Type Unspecified
PA696607GDNMedicare PIN
PAS38183Medicare UPIN