Healthcare Provider Details

I. General information

NPI: 1710974464
Provider Name (Legal Business Name): SUZANNE K FREITAG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST 10TH FLOOR
BOSTON MA
02114-3002
US

IV. Provider business mailing address

243 CHARLES ST 10TH FLOOR
BOSTON MA
02114-3002
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-5529
  • Fax: 617-573-5525
Mailing address:
  • Phone: 617-573-5529
  • Fax: 617-573-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number160016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: