Provider Demographics
NPI:1831102276
Name:FREEMAN, RUDOLPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:
Last Name:FREEMAN
Suffix:JR
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 1:297 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2911
Mailing Address - Country:US
Mailing Address - Phone:757-385-0511
Mailing Address - Fax:757-473-5161
Practice Address - Street 1:11818 ROCK LANDING DR STE 101
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4394
Practice Address - Country:US
Practice Address - Phone:757-595-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010330702084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831102276OtherANTHEM
VA1831102276OtherOPTIMA
VA1861562472OtherVIRGINIA PREMIER
VA1861562472Medicaid
1831102276OtherANTHEM
VAC03534Medicare PIN