Healthcare Provider Details

I. General information

NPI: 1427033364
Provider Name (Legal Business Name): GINA M FREEMAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 PENNSYLVANIA AVE STE 2B
WILMINGTON DE
19806-1332
US

IV. Provider business mailing address

PO BOX 9551
WILMINGTON DE
19809
US

V. Phone/Fax

Practice location:
  • Phone: 302-765-2505
  • Fax: 302-384-8046
Mailing address:
  • Phone: 302-765-2505
  • Fax: 302-765-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberEI0000136
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: