Provider Demographics
NPI:1225915515
Name:FREEBERY, LAUREN KELLY (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KELLY
Last Name:FREEBERY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-645-3499
Mailing Address - Fax:302-644-4830
Practice Address - Street 1:33672 BAYVIEW MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1687
Practice Address - Country:US
Practice Address - Phone:302-703-3630
Practice Address - Fax:302-645-8473
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0012317208600000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant