Provider Demographics
NPI:1497827612
Name:FREITAS, DANIEL F (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:F
Last Name:FREITAS
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 1:24 LYMAN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1484
Mailing Address - Country:US
Mailing Address - Phone:508-366-7100
Mailing Address - Fax:508-366-7303
Practice Address - Street 1:24 LYMAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1482
Practice Address - Country:US
Practice Address - Phone:508-366-7100
Practice Address - Fax:508-366-7303
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3087719Medicaid
MAJ11989Medicare ID - Type Unspecified
MA3087719Medicaid