Basic Information
Provider Information | |||||||||
NPI: | 1992811509 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAGLIERI | ||||||||
FirstName: | ANNA MARIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 940 COMMONWEALTH AVE SUITE 2 | ||||||||
Address2: | NEW ENGLAND EYE INSTITUTE | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 02215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6172622020 | ||||||||
FaxNumber: | 6172366323 | ||||||||
Practice Location | |||||||||
Address1: | 930 COMMONWEALTH AVE SUITE 2A | ||||||||
Address2: | NEW ENGLAND EYE INSTITUTE | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 02215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6172622020 | ||||||||
FaxNumber: | 6172366323 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2006 | ||||||||
LastUpdateDate: | 01/18/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WP0200X | 4542 | MA | Y |   | Eye and Vision Services Providers | Optometrist | Pediatrics |
ID Information
ID | Type | State | Issuer | Description | AA51781 | 01 |   | HARVARD PILGRIM | OTHER | 37399 | 01 |   | NEIGHBORHOOD HEALTH PLAN | OTHER | W16472 | 01 |   | BLUE CROSS BS | OTHER |