Provider Demographics
NPI:1477204956
Name:LOUIMARRE, FREUD JOSEPH (PA)
Entity Type:Individual
Prefix:DR
First Name:FREUD
Middle Name:JOSEPH
Last Name:LOUIMARRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOLYOKE ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5607
Mailing Address - Country:US
Mailing Address - Phone:339-545-6273
Mailing Address - Fax:
Practice Address - Street 1:33 HOLYOKE ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5607
Practice Address - Country:US
Practice Address - Phone:339-545-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1148-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty