Provider Demographics
NPI:1295117067
Name:FREEZE, SAMANTHA (MS)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:FREEZE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RILEY HOSPITAL DR
Mailing Address - Street 2:RI-2606
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-278-3153
Mailing Address - Fax:317-278-7856
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI-2606
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-278-3153
Practice Address - Fax:317-278-7856
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS