Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 74467 | MA |
NPI | 1013907542 |
---|---|
Provider Name | Dr. Douglas Eric Raines |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3081371 | (05) | MA |
757786 | TUFTS HEALTH PLAN (01) | MA |
E95634 | (02) | |
J11454 | BCBS MA (01) | MA |