Healthcare Provider Details

I. General information

NPI: 1750625968
Provider Name (Legal Business Name): MICHAEL DAVID FREEDMAN I M.D.,F.A.C.P.,F.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 WAINWRIGHT CIR
OWINGS MILLS MD
21117-5832
US

IV. Provider business mailing address

4730 WAINWRIGHT CIR
OWINGS MILLS MD
21117-5832
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-3355
  • Fax:
Mailing address:
  • Phone: 410-363-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License NumberD0043798
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberD0043798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: