Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 157760 | MA |
N | 111NI0900X | Internist | 157760 | MA |
N | 207RA0401X | Internist - Addiction Medicine | 157760 | MA |
NPI | 1962472894 |
---|---|
Provider Name | Kenneth Freedman |
First Address | Jamaica Plain, MA 02130-3735 |
Second Address | Jamaica Plain, MA 02130-3735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F56587 | (02) |