Provider Demographics
NPI:1932168812
Name:FREEDMAN, MICHAEL DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 WASHINGTON STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-471-0800
Mailing Address - Fax:845-471-0811
Practice Address - Street 1:207 WASHINGTON STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-471-0800
Practice Address - Fax:845-471-0811
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134278-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00612313Medicaid
NY52A51EY221Medicare PIN
NYC10999Medicare UPIN