Provider Demographics
NPI:1174559546
Name:BARNETT MEDICAL ASSOCIATES,PC
Entity type:Organization
Organization Name:BARNETT MEDICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-306-3677
Mailing Address - Street 1:745 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1941
Mailing Address - Country:US
Mailing Address - Phone:617-364-0222
Mailing Address - Fax:617-364-3470
Practice Address - Street 1:745 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1941
Practice Address - Country:US
Practice Address - Phone:617-364-0222
Practice Address - Fax:617-364-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA778089OtherUSHEALTHCARE
MA3056597Medicaid
MA65492OtherHPHC
MA778089OtherUSHEALTHCARE
MA65492OtherHPHC