Healthcare Provider Details

I. General information

NPI: 1942694484
Provider Name (Legal Business Name): MARTIN STOKES FREEMAN BA, MTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 CHAGRIN BLVD STE 900
SHAKER HEIGHTS OH
44122-5362
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-7239
  • Fax:
Mailing address:
  • Phone: 216-295-7239
  • Fax: 216-295-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0020668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: