Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 73199 | MA |
NPI | 1124088745 |
---|---|
Provider Name | Mary Christine Bailey |
First Address | Newton, MA 02461 |
Second Address | Newton, MA 02462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3078647 | (05) | MA |
436574 | HP (01) | |
731682 | TUFTS (01) | |
F35908 | (02) | |
J11338 | BLUE SHIELD (01) |