Provider Demographics
NPI:1558564773
Name:FREEDY, LUCY R (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:R
Last Name:FREEDY
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 1:3605 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:MSC 9152
Mailing Address - City:SHAKER HGTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC240442085N0700X, 2085N0904X
OH35.023382085B0100X, 2085N0700X, 2085N0904X, 2085U0001X
NC108112085B0100X, 2085N0700X, 2085N0904X, 2085U0001X
FLME971472085B0100X, 2085N0700X, 2085N0904X, 2085U0001X
OH35-0233382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4306279OtherAETNA
OH0304914OtherBCMH
OH0488379Medicaid
OH421782OtherWELLCARE
OH727197OtherBUCKEYE
OH000000547444OtherANTHEM
OH421782OtherWELLCARE
OH000000547444OtherANTHEM