Provider Demographics
NPI:1720054646
Name:FREEMAN, FREDERICK E (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:E
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:E
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1010 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-3447
Mailing Address - Country:US
Mailing Address - Phone:843-784-8297
Mailing Address - Fax:843-784-7998
Practice Address - Street 1:1010 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-3447
Practice Address - Country:US
Practice Address - Phone:843-784-8297
Practice Address - Fax:843-784-7998
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40530207Y00000X
SC36474207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040014886OtherRAIL ROAD MEDICARE
FL043013700Medicaid
SC364741Medicaid
SCSC2635A823Medicare PIN
040014886OtherRAIL ROAD MEDICARE
040014886OtherRAIL ROAD MEDICARE