Provider Demographics
NPI:1366406720
Name:FREEDMAN, EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 ELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2705
Mailing Address - Country:US
Mailing Address - Phone:860-648-2447
Mailing Address - Fax:
Practice Address - Street 1:1665 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2705
Practice Address - Country:US
Practice Address - Phone:860-648-2447
Practice Address - Fax:860-644-0874
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0216992080A0000X
CT21699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE10245Medicare UPIN