Provider Demographics
NPI:1033296249
Name:FREEMAN, AMANDA BAUTISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BAUTISTA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1958
Mailing Address - Country:US
Mailing Address - Phone:617-965-1808
Mailing Address - Fax:617-969-0668
Practice Address - Street 1:98 SUMNER ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1958
Practice Address - Country:US
Practice Address - Phone:617-965-1808
Practice Address - Fax:617-969-0668
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics