Provider Demographics
NPI:1578619086
Name:FRELIECH, JEANINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:T
Last Name:FRELIECH
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 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1931
Mailing Address - Country:US
Mailing Address - Phone:617-569-5800
Mailing Address - Fax:
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1931
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036062208000000X
MA79511208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics