Provider Demographics
NPI:1386628501
Name:BAROUCH, FINA CANAS (MD)
Entity Type:Individual
Prefix:
First Name:FINA
Middle Name:CANAS
Last Name:BAROUCH
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 1:1 ESSEX CENTER DR
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2901
Mailing Address - Country:US
Mailing Address - Phone:978-538-4400
Mailing Address - Fax:978-538-4724
Practice Address - Street 1:1 ESSEX CENTER DR
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-4400
Practice Address - Fax:978-538-4724
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220431207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110038682AMedicaid
MA110038682AMedicaid
MAI09131Medicare UPIN