Provider Demographics
NPI:1023284148
Name:FREED, GARY LELAND JR (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LELAND
Last Name:FREED
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC PLASTIC SURGERY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5148
Mailing Address - Fax:603-650-8456
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC PLASTIC SURGERY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5148
Practice Address - Fax:603-650-8456
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH15218208200000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090698AMedicaid
VT1019432Medicaid
NH32000757Medicaid
VT1019432Medicaid
MA110090698AMedicaid