Healthcare Provider Details

I. General information

NPI: 1093943276
Provider Name (Legal Business Name): NATASHA NICHOLE FREDERICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

300 LONGWOOD AVE KARP 8
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-8948
  • Fax: 860-545-9622
Mailing address:
  • Phone: 617-919-3041
  • Fax: 617-730-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP01770
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number250383
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number56414
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: