Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101043977 | VA |
NPI | 1316922503 |
---|---|
Provider Name | Dr. Bruce M Freedman |
First Address | Reston, VA 20190-3240 |
Second Address | Reston, VA 20190-3240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C98506 | (02) | VA |