Provider Demographics
NPI:1750382453
Name:FREED, LISA A (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:FREED
Suffix:
Gender:F
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEVINE STREET
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2193
Mailing Address - Country:US
Mailing Address - Phone:203-287-3960
Mailing Address - Fax:203-287-3956
Practice Address - Street 1:2 DEVINE STREET
Practice Address - Street 2:SUITE # 1
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2193
Practice Address - Country:US
Practice Address - Phone:203-789-2272
Practice Address - Fax:203-865-8614
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001375890Medicaid
CTP00396903OtherMEDICARE RAILROAD PIN
CTP00396903OtherMEDICARE RAILROAD PIN
G67310Medicare UPIN
CT060001813Medicare PIN