Provider Demographics
NPI:1194738963
Name:FREEDMAN, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-452-8322
Mailing Address - Fax:203-452-2296
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 215
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-452-8322
Practice Address - Fax:203-452-2296
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0200722080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001200724Medicaid
CTE31755Medicare UPIN