Healthcare Provider Details

I. General information

NPI: 1033296249
Provider Name (Legal Business Name): AMANDA BAUTISTA FREEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 SUMNER ST
NEWTON CENTER MA
02459-1958
US

IV. Provider business mailing address

98 SUMNER ST
NEWTON CENTER MA
02459-1958
US

V. Phone/Fax

Practice location:
  • Phone: 617-965-1808
  • Fax: 617-969-0668
Mailing address:
  • Phone: 617-965-1808
  • Fax: 617-969-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34068
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: