Healthcare Provider Details

I. General information

NPI: 1366406720
Provider Name (Legal Business Name): EILEEN FREEDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 ELLINGTON RD
SOUTH WINDSOR CT
06074-2705
US

IV. Provider business mailing address

1665 ELLINGTON RD
SOUTH WINDSOR CT
06074-2705
US

V. Phone/Fax

Practice location:
  • Phone: 860-648-2447
  • Fax: 860-644-0874
Mailing address:
  • Phone: 860-648-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number021699
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21699
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: