Provider Demographics
NPI:1811960966
Name:FREEMAN, MARLENE H (MD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:H
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARLENE
Other - Middle Name:ELIZABETH
Other - Last Name:HARGREAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2702 LOW CT
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9771
Practice Address - Country:US
Practice Address - Phone:707-432-2810
Practice Address - Fax:707-432-2800
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87122207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52023Medicare UPIN
00G87122Medicare ID - Type Unspecified
00G871220Medicare ID - Type Unspecified