Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 71508 | MA |
Y | 111NI0900X | Internist | 71508 | MA |
NPI | 1003018367 |
---|---|
Provider Name | John D Freedman |
First Address | Newton, MA 02458-1275 |
Second Address | Newton, MA 02458-1275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 30/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E92935 | (02) | MA |