Healthcare Provider Details

I. General information

NPI: 1831102276
Provider Name (Legal Business Name): RUDOLPH FREEMAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 ROCK LANDING DR STE 101
NEWPORT NEWS VA
23606-4394
US

IV. Provider business mailing address

297 INDEPENDENCE BLVD SUITE 126
VIRGINIA BEACH VA
23462-2911
US

V. Phone/Fax

Practice location:
  • Phone: 757-595-3900
  • Fax:
Mailing address:
  • Phone: 757-385-0511
  • Fax: 757-473-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101033070
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0101033070
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: