Provider Demographics
NPI:1679665442
Name:FRECCERO, EDWARD FRANCIS (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:FRANCIS
Last Name:FRECCERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 BRYON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4201
Mailing Address - Country:US
Mailing Address - Phone:508-583-7595
Mailing Address - Fax:508-559-2278
Practice Address - Street 1:77 BRYON AVENUE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4201
Practice Address - Country:US
Practice Address - Phone:508-583-7595
Practice Address - Fax:508-559-2278
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA151454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
15454OtherTUFTS HEALTHCARE
3078300OtherAETNA
MA3191575Medicaid
J16953OtherBCBS
M19070OtherBCBS GROUP
0077646OtherNEIBORHOOD HEALTH PLAN
0403406OtherUNITED HEALTHCARE
110192524OtherRAILROAD MEDICARE
66675OtherHARVARD PILGRIM
0403406OtherUNITED HEALTHCARE
110192524OtherRAILROAD MEDICARE