Provider Demographics
NPI:1710977038
Name:FREUDENREICH, OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:FREUDENREICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-912-7800
Mailing Address - Fax:617-723-3919
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:LIN PSYCHIATRY ASSOCIATES INPATIENT CONSULT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-912-7800
Practice Address - Fax:617-723-3919
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-01-03
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Provider Licenses
StateLicense IDTaxonomies
MA1597032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ21267OtherBCBS MA
MA159703OtherTUFTS HEALTH PLAN
MA3195660Medicaid
G91734Medicare UPIN
MA3195660Medicaid