Healthcare Provider Details

I. General information

NPI: 1740246107
Provider Name (Legal Business Name): FREEDA J FLYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67609 WARNOCK ST CLAIRSVILLE RD
SAINT CLAIRSVILLE OH
43950-9129
US

IV. Provider business mailing address

PO BOX 706
SAINT CLAIRSVILLE OH
43950-0706
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-5190
  • Fax: 740-695-5191
Mailing address:
  • Phone: 740-695-5190
  • Fax: 740-695-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35066409
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17548
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: