=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962472894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH FREEDMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 MORTON ST
-----------------------------------------------------
City | JAMAICA PLAIN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-971-3532
-----------------------------------------------------
Fax | 617-971-3852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 170 MORTON ST
-----------------------------------------------------
City | JAMAICA PLAIN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-971-3532
-----------------------------------------------------
Fax | 617-971-3852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 157760
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0008X
-----------------------------------------------------
Taxonomy Name | Hepatology Physician
-----------------------------------------------------
License Number | 157760
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 157760
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------