Basic Information
| Provider Information | |||||||||
| NPI: | 1558564773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEDY | ||||||||
| FirstName: | LUCY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 WARRENSVILLE CENTER ROAD | ||||||||
| Address2: | MSC 9152 | ||||||||
| City: | SHAKER HGTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162866299 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVENUE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | C24044 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | C24044 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085B0100X | 35.02338 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 35.02338 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 35.02338 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085U0001X | 35.02338 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085B0100X | 10811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 10811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 10811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085U0001X | 10811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085B0100X | ME97147 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | ME97147 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | ME97147 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085U0001X | ME97147 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | 35-023338 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4306279 | 01 | OH | AETNA | OTHER | 0304914 | 01 | OH | BCMH | OTHER | 0488379 | 05 | OH | MEDICAID | 421782 | 01 | OH | WELLCARE | OTHER | 727197 | 01 | OH | BUCKEYE | OTHER | 000000547444 | 01 | OH | ANTHEM | OTHER |