Provider Demographics
NPI:1003018367
Name:FREEDMAN, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CRAFTS ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1275
Mailing Address - Country:US
Mailing Address - Phone:617-243-9509
Mailing Address - Fax:
Practice Address - Street 1:29 CRAFTS ST
Practice Address - Street 2:SUITE 470
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1275
Practice Address - Country:US
Practice Address - Phone:617-243-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE92935Medicare UPIN