Healthcare Provider Details

I. General information

NPI: 1124025051
Provider Name (Legal Business Name): PETER FREEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 TELEGRAPH AVE 103
BERKELEY CA
94705-2051
US

IV. Provider business mailing address

3031 TELEGRAPH AVE 103
BERKELEY CA
94705-2051
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-3287
  • Fax:
Mailing address:
  • Phone: 510-549-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG 33020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: