Basic Information
| Provider Information | |||||||||
| NPI: | 1609967298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREIDIN | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CHANNEL CENTER | ||||||||
| Address2: | UNIT 1102 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022103414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172049239 | ||||||||
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| Practice Location | |||||||||
| Address1: | 57 BEDFORD STREET | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024200001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818627500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35636 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2033054 | 05 | MA | MEDICAID |