1497411193 NPI number — MRS. EMA ALICE BARBOSA BROWN RD

Table of content: MRS. EMA ALICE BARBOSA BROWN RD (NPI 1497411193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497411193 NPI number — MRS. EMA ALICE BARBOSA BROWN RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBOSA BROWN
Provider First Name:
EMA
Provider Middle Name:
ALICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497411193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 ROCKLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02021-3192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-489-1729
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BWH AND BWH-FAULKNER HOSPITAL
Provider Second Line Business Practice Location Address:
75 FRANCIS ST, ASBII 3RD FLOOR & 5TH FL. FH SUITE D
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-732-8884
Provider Business Practice Location Address Fax Number:
617-264-6315
Provider Enumeration Date:
11/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1201X , with the licence number:  2354 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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