Provider Demographics
NPI:1528045606
Name:FREEDMAN, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S CHERRY GROVE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4235
Mailing Address - Country:US
Mailing Address - Phone:844-322-4222
Mailing Address - Fax:410-897-9852
Practice Address - Street 1:509 S CHERRY GROVE AVE STE C
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4235
Practice Address - Country:US
Practice Address - Phone:844-322-4222
Practice Address - Fax:443-400-0509
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52245207R00000X
MDD0052245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0052245OtherMEDICAL LICENSE
G50254Medicare UPIN