Provider Demographics
NPI:1366641888
Name:FREDERICK L. MANSFIELD, M.D., P.C.
Entity Type:Organization
Organization Name:FREDERICK L. MANSFIELD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-726-5919
Mailing Address - Street 1:0 EMERSON PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2241
Mailing Address - Country:US
Mailing Address - Phone:617-726-5919
Mailing Address - Fax:617-742-7849
Practice Address - Street 1:0 EMERSON PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2241
Practice Address - Country:US
Practice Address - Phone:617-726-5919
Practice Address - Fax:617-742-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44332207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18868OtherBC/BS OF MASSACHUSETTS
MAA54789Medicare UPIN