Healthcare Provider Details

I. General information

NPI: 1023284148
Provider Name (Legal Business Name): GARY LELAND FREED JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC PLASTIC SURGERY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC PLASTIC SURGERY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5148
  • Fax: 603-650-8456
Mailing address:
  • Phone: 603-650-5148
  • Fax: 603-650-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15218
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number15218
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: