Provider Demographics
NPI:1184626947
Name:FREEMAN, ERIC JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JONATHAN
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 1:4053 TAYLOR RD
Mailing Address - Street 2:STE N
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5537
Mailing Address - Country:US
Mailing Address - Phone:757-484-5900
Mailing Address - Fax:757-483-6671
Practice Address - Street 1:4053 TAYLOR RD
Practice Address - Street 2:STE N
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5537
Practice Address - Country:US
Practice Address - Phone:757-484-5900
Practice Address - Fax:757-483-6671
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023249207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6075932Medicaid
C47602Medicare UPIN
111949974Medicare ID - Type Unspecified
VA6075932Medicaid