Provider Demographics
NPI:1609967298
Name:FREIDIN, RALPH B (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:B
Last Name:FREIDIN
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 1:25 CHANNEL CENTER
Mailing Address - Street 2:UNIT 1102
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-3414
Mailing Address - Country:US
Mailing Address - Phone:617-204-9239
Mailing Address - Fax:
Practice Address - Street 1:57 BEDFORD STREET
Practice Address - Street 2:SUITE 130
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-0001
Practice Address - Country:US
Practice Address - Phone:781-862-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2033054Medicaid
MAB76253Medicare UPIN
MAM08885Medicare ID - Type Unspecified