Provider Demographics
NPI:1275594277
Name:FREAS, ROSALIND A (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:A
Last Name:FREAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8954
Mailing Address - Country:US
Mailing Address - Phone:321-777-9091
Mailing Address - Fax:
Practice Address - Street 1:2571 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8954
Practice Address - Country:US
Practice Address - Phone:321-777-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070009963OtherRAIL ROAD MEDICARE
FL251163100Medicaid
G38270Medicare UPIN
FL251163100Medicaid