Provider Demographics
NPI:1548241334
Name:FREDERICK, ALBERT R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:R
Last Name:FREDERICK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-06-06
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Provider Licenses
StateLicense IDTaxonomies
MA27502207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM07168OtherBCBS MA
MA2027976Medicaid
MA2027976Medicaid
DX3362Medicare PIN
B76319Medicare UPIN