Provider Demographics
NPI:1740246107
Name:FLYNN, FREEDA J (MD)
Entity type:Individual
Prefix:DR
First Name:FREEDA
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:F
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:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-0706
Mailing Address - Country:US
Mailing Address - Phone:740-695-5190
Mailing Address - Fax:740-695-5191
Practice Address - Street 1:67609 WARNOCK ST CLAIRSVILLE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9129
Practice Address - Country:US
Practice Address - Phone:740-695-5190
Practice Address - Fax:740-695-5191
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066409207Q00000X
WV17548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0137971Medicaid
OH0137971Medicaid
OHG00795Medicare UPIN