Provider Demographics
NPI:1033222195
Name:BAEZ, AMADO ALEJANDRO (MD, MSC, MPH)
Entity Type:Individual
Prefix:
First Name:AMADO
Middle Name:ALEJANDRO
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MD, MSC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:DEPT OF EMERGENCY MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-525-8466
Mailing Address - Fax:617-732-6336
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-525-8466
Practice Address - Fax:617-732-6336
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226538146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA39751Medicare ID - Type UnspecifiedPROVIDER NUMBER