Provider Demographics
NPI:1316922503
Name:FREEDMAN, BRUCE M (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TOWN CENTER DR
Mailing Address - Street 2:STE 413
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3240
Mailing Address - Country:US
Mailing Address - Phone:703-790-5700
Mailing Address - Fax:703-827-8730
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:STE 413
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3240
Practice Address - Country:US
Practice Address - Phone:703-790-5700
Practice Address - Fax:703-827-8730
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010439772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC98506Medicare UPIN
VA561047B21Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMB