Provider Demographics
NPI:1457338576
Name:FRETER, ROLF (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROLF
Middle Name:
Last Name:FRETER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7117
Mailing Address - Fax:508-941-6117
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7117
Practice Address - Fax:508-941-6117
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59350207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA31778Medicare PIN
MA14700OtherHARVARD PILGRIM
MA3092836Medicaid
MA0036427OtherNEIGHBORHOOD HEALTH PLAN
MAJ09294OtherBLUE CROSS BLUE SHIELD
MAE37958Medicare UPIN
MA059350OtherTUFTS HEALTH PLAN
MA60835OtherFALLON COMM HEALTH PLAN