Provider Demographics
NPI:1679655245
Name:FREEDMAN, MALCOLM ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:ROBERT
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 1:6440 BIGELOW COMMONS
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3354
Mailing Address - Country:US
Mailing Address - Phone:860-604-5578
Mailing Address - Fax:860-741-8685
Practice Address - Street 1:490 PAGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3026
Practice Address - Country:US
Practice Address - Phone:413-349-5033
Practice Address - Fax:413-363-9123
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS73672084P0800X
NJ25MB074880002084P0800X
AZ42302084P0800X
CT0393142084P0800X
PAOS0121882084P0800X
MA2065662084P0800X
NV12082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH63535Medicare UPIN