Provider Demographics
NPI:1841264256
Name:FREEMAN, GLENN (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:FREEMAN
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34295-0339
Mailing Address - Country:US
Mailing Address - Phone:941-223-0555
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:DELPHI ORTHOPEDIC CLINIC ON C-1
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5540
Practice Address - Fax:860-224-5942
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214250207X00000X
FLME84747207X00000X
VA0101040787207X00000X
ME015946207X00000X
FL84747207X00000X
NC2007-00852207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMM968902OtherMEDICARE PTAN
B09650Medicare UPIN
VA021360C82Medicare PIN