Provider Demographics
NPI:1154334357
Name:BACHTA, MADELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:BACHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHESTNUT ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2497
Mailing Address - Country:US
Mailing Address - Phone:781-449-5224
Mailing Address - Fax:781-449-0520
Practice Address - Street 1:300 CHESTNUT ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2497
Practice Address - Country:US
Practice Address - Phone:781-449-5224
Practice Address - Fax:781-449-0520
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34991207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA66766Medicare UPIN
MAM08864Medicare PIN