MEDICARE: KENNETH FREEDMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	157760	MA
2	207RI0008X	Hepatology Physician	157760	MA
3	207RA0401X	Addiction Medicine (Internal Medicine) Physician	157760	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962472894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH FREEDMAN M.D.

Provider Business Mailing Address
First Line	:	170 MORTON ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3735
Country	:	US
Telephone Number	:	617-971-3532
Fax Number	:	617-971-3852

Provider Business Practice Location Address
First Line	:	170 MORTON ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3735
Country	:	US
Telephone Number	:	617-971-3532
Fax Number	:	617-971-3852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	09/11/2025

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