Healthcare Provider Details

I. General information

NPI: 1184629875
Provider Name (Legal Business Name): JAMES W FRESTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3238
  • Fax: 860-679-1217
Mailing address:
  • Phone: 860-523-6421
  • Fax: 860-523-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number022341
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: