1801011465 NPI number — DR. BRIAN J BAKOFEN DO

Table of content: DR. BRIAN J BAKOFEN DO (NPI 1801011465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801011465 NPI number — DR. BRIAN J BAKOFEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKOFEN
Provider First Name:
BRIAN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1801011465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 BOYLSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215-4302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-267-0900
Provider Business Mailing Address Fax Number:
617-247-3460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 BOYLSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-267-0900
Provider Business Practice Location Address Fax Number:
617-247-3460
Provider Enumeration Date:
04/17/2007

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: 207R00000X , with the licence number:  235485 , 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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