Provider Demographics
NPI:1174543532
Name:FREY, GERALD E JR (PA-C)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:FREY
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTERN MARYLAND PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5471
Mailing Address - Country:US
Mailing Address - Phone:301-797-6389
Mailing Address - Fax:301-797-4119
Practice Address - Street 1:13 WESTERN MARYLAND PKWY STE 106
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6474
Practice Address - Country:US
Practice Address - Phone:240-513-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003097363A00000X
PAMA051226363AM0700X
MDC0002608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00670464OtherRR MEDICARE
MDP00122897OtherRR MEDICARE
PAP00670464OtherRR MEDICARE
MDP86190Medicare UPIN
MD602LF605Medicare PIN