MEDICARE: JILL REBECCA SLATER-FREEDBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	77571	MA

General Provider Information

NPI Number	:	1255389425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL REBECCA SLATER-FREEDBERG M.D.

Provider Business Mailing Address
First Line	:	223 GLEZEN LN
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-1520
Country	:	US
Telephone Number	:	781-862-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 BEDFORD STREET
Second Line	:	LEXINGTON WALTHAM DERMATOLOGY
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4500
Country	:	US
Telephone Number	:	781-862-2322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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