Provider Demographics
NPI:1336290063
Name:FREEMAN, STEPHEN (MPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5494
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2977 MANCHESTER RD
Practice Address - Street 2:STE A
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1802
Practice Address - Country:US
Practice Address - Phone:410-374-8410
Practice Address - Fax:410-374-8409
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19451208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
47610189OtherCAREFIRST BCBS PROVIDER #
MD69772203OtherBCBS REGION RENDERING #
44565OtherIWIF PROVIDER NUMBER
310822OtherMDIPA, MAMSI, OPT CHOICE
7647074OtherAETNA PROVIDER NUMBER
310822OtherALLIANCE PROVIDER NUMBER
MD023348001Medicaid
1939107OtherUNITEDHEALTHCARE PROVIDER