Provider Demographics
NPI:1154308211
Name:FREEDMAN, ELIZABETH S (MD)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHURCH RD
Mailing Address - Street 2:PO BOX 518
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-0518
Mailing Address - Country:US
Mailing Address - Phone:860-653-4526
Mailing Address - Fax:860-653-5209
Practice Address - Street 1:13 CHURCH RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-0518
Practice Address - Country:US
Practice Address - Phone:860-653-4526
Practice Address - Fax:860-653-5307
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001375072Medicaid
010037507CT09OtherBCBS
0V8892VOtherHEALTHNET
7308182OtherAETNA
037507OtherCT
P2195400OtherOXFORD
6609B9002OtherCIGNA
010037507CT09OtherBCBS
037507OtherCT