Provider Demographics
NPI:1952511016
Name:FREEMAN, RICHARD WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WALTER
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 1:10 GREYLOCK RDG
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2318
Mailing Address - Country:US
Mailing Address - Phone:908-601-3687
Mailing Address - Fax:
Practice Address - Street 1:10 GREYLOCK RDG
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2318
Practice Address - Country:US
Practice Address - Phone:908-601-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223897-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE33249Medicare UPIN