Provider Demographics
NPI:1821100587
Name:FREEDMAN, LISA NAN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NAN
Last Name:FREEDMAN
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 1:5800 HERITAGE LANDING DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9378
Mailing Address - Country:US
Mailing Address - Phone:315-471-6442
Mailing Address - Fax:315-471-3074
Practice Address - Street 1:5800 HERITAGE LANDING DR
Practice Address - Street 2:SUITE B
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9378
Practice Address - Country:US
Practice Address - Phone:315-471-6442
Practice Address - Fax:315-471-3074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1854361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E92562Medicare UPIN
BA0087Medicare PIN