Provider Demographics
NPI:1124909262
Name:FREZZELL, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:FREZZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:HOPWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15445-2128
Mailing Address - Country:US
Mailing Address - Phone:412-491-2395
Mailing Address - Fax:
Practice Address - Street 1:141 LOCUST ST
Practice Address - Street 2:
Practice Address - City:HOPWOOD
Practice Address - State:PA
Practice Address - Zip Code:15445-2128
Practice Address - Country:US
Practice Address - Phone:412-491-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)