Provider Demographics
NPI:1891785325
Name:MANSFIELD, FREDERICK L (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
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 1:0 EMERSON PL
Practice Address - Street 2:SUITE 120 E00-120
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2241
Practice Address - Country:US
Practice Address - Phone:617-726-5919
Practice Address - Fax:617-742-7849
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA44332207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0152269Medicaid
MAE05637OtherBCBS MA
MA714668OtherTUFTS HEALTH PLAN
MAE05637OtherBCBS MA
MA714668OtherTUFTS HEALTH PLAN