Basic Information
| Provider Information | |||||||||
| NPI: | 1215908132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KAVANAGH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 WORCESTER ST | ||||||||
| Address2: | |||||||||
| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024815420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814315220 | ||||||||
| FaxNumber: | 7814315526 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 WORCESTER ST | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024815420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814315220 | ||||||||
| FaxNumber: | 7814315371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 79150 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | J31749 | 01 | MA | BLUE CROSS | OTHER | 079150 | 01 | MA | TUFTS | OTHER | 3185648 | 05 | MA | MEDICAID | PV595 | 01 | MA | HARVARD PILGRIM | OTHER |