Provider Demographics
NPI:1578802237
Name:FREEMAN, LAWRENCE CHARLES
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:CHARLES
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:CHARLES
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26 WOODCREEK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3255
Mailing Address - Country:US
Mailing Address - Phone:513-731-1810
Mailing Address - Fax:513-731-3021
Practice Address - Street 1:26 WOODCREEK DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-3255
Practice Address - Country:US
Practice Address - Phone:513-731-1810
Practice Address - Fax:513-731-3021
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.032654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist