Provider Demographics
NPI:1245404524
Name:FREEDMAN, BRUCE MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1304
Mailing Address - Country:US
Mailing Address - Phone:276-964-9633
Mailing Address - Fax:
Practice Address - Street 1:6719 GOVERNOR GC PEERY HWY
Practice Address - Street 2:STE 1900
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-0349
Practice Address - Country:US
Practice Address - Phone:276-964-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA351213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X6022B01Medicare PIN
VA480000022Medicare PIN
VAT21428Medicare UPIN