Healthcare Provider Details

I. General information

NPI: 1295706539
Provider Name (Legal Business Name): DAVID M FRECCERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET SHAPIRO 4, SUITE B
BOSTON MA
02118
US

IV. Provider business mailing address

801 ALBANY ST # 503
BOSTON MA
02119-2560
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-5633
  • Fax: 617-414-5226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12960
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number220583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: