Provider Demographics
NPI:1710944756
Name:FREEMAN, MARSHALL CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:CRAIG
Last Name:FREEMAN
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 1:1414 YANCEYVILLE STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6930
Mailing Address - Country:US
Mailing Address - Phone:336-574-8000
Mailing Address - Fax:336-574-8008
Practice Address - Street 1:1414 YANCEYVILLE STREET
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6930
Practice Address - Country:US
Practice Address - Phone:336-574-8000
Practice Address - Fax:336-574-8008
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200900174400000X
NC2002-009002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1313COtherBCBSNC
NC5900990Medicaid
NC2027658Medicare ID - Type Unspecified
NC1313COtherBCBSNC