Basic Information
| Provider Information | |||||||||
| NPI: | 1275507006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREED | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845628 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022845628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009270002 | ||||||||
| FaxNumber: | 6038938886 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021155724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173556793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 35101 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | B20086701 | 01 | MA | CIGNA MA | OTHER | 99342502 | 01 | MA | NETWORK HEALTH | OTHER | AA9213 | 01 | MA | HARVARD PILGRIM | OTHER | UNITED HEALTHCARE MA | 01 | MA | 7500136 | OTHER | M08390 | 01 | MA | BCBS MA | OTHER | 6161 | 01 | MA | HEALTH NET | OTHER | MF03667 | 05 | RI | MEDICAID | 7500136 | 01 | MA | UNITED HEALTHCARE MA | OTHER |