Provider Demographics
NPI:1841298015
Name:FREEMAN, DENISE A (DO)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TITUS PL
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1457
Mailing Address - Country:US
Mailing Address - Phone:607-865-2400
Mailing Address - Fax:607-865-7304
Practice Address - Street 1:RT 30 MAIN STREET
Practice Address - Street 2:BOX 327
Practice Address - City:DOWNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13755
Practice Address - Country:US
Practice Address - Phone:607-363-2517
Practice Address - Fax:607-363-7856
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2059631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01865874Medicaid
NY6T2361Medicare ID - Type Unspecified
NY01865874Medicaid