Provider Demographics
NPI:1801829965
Name:FREELAND, HENRY THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:THEODORE
Last Name:FREELAND
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 1:155 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3232
Mailing Address - Country:US
Mailing Address - Phone:510-521-4323
Mailing Address - Fax:510-521-5623
Practice Address - Street 1:512 WESTLINE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7649
Practice Address - Country:US
Practice Address - Phone:510-521-4323
Practice Address - Fax:510-521-5623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG210442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G210441Medicaid
CA00G210441Medicaid
A89338Medicare UPIN