Provider Demographics
NPI:1548893985
Name:FREEMAN, ERNEST
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 MAIN ST.
Mailing Address - Street 2:LAUREL
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-604-4000
Mailing Address - Fax:770-435-4949
Practice Address - Street 1:367 MAIN ST.
Practice Address - Street 2:LAUREL
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-604-4000
Practice Address - Fax:770-435-4949
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care