Provider Demographics
NPI:1396724415
Name:FREEMAN, JENNY E (MD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:E
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ASH ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1927
Mailing Address - Country:US
Mailing Address - Phone:781-760-5569
Mailing Address - Fax:
Practice Address - Street 1:411 WAVERLY OAKS RD
Practice Address - Street 2:#150
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8448
Practice Address - Country:US
Practice Address - Phone:781-373-1636
Practice Address - Fax:781-373-1653
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152076208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA304784OtherHARVARD PILGRIM HEALTHCAR
MA772242OtherTUFTS HEALTH PLAN
MA2010453Medicaid
MAJ18740OtherBCBSMA
MAE04408Medicare UPIN
MAA29016Medicare ID - Type Unspecified