Healthcare Provider Details

I. General information

NPI: 1063767200
Provider Name (Legal Business Name): DARREL C FREEMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

2420 W ROGERS AVE
BALTIMORE MD
21209-4322
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-1588
  • Fax: 443-458-6775
Mailing address:
  • Phone: 207-409-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR176480
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR176480
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: