Provider Demographics
NPI:1407866619
Name:BAXTER, JEFFREY D (FAMILY PRACTICE)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:BAXTER
Suffix:
Gender:M
Credentials:FAMILY PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MECHANIC ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2420
Mailing Address - Country:US
Mailing Address - Phone:508-792-5400
Mailing Address - Fax:508-831-0074
Practice Address - Street 1:585 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1906
Practice Address - Country:US
Practice Address - Phone:508-831-0045
Practice Address - Fax:508-831-0074
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157945207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003961OtherNEIGHBORHOOD HEALTH PLAN
MA0103677OtherUNITED HEALTH CARE
MA99733701OtherNETWORK HEALTH
MAY10141OtherBCBS-GROUP
MA6032012002OtherCIGNA
MAJ22851OtherBCBS
MAAA9738OtherHARVARD PILGRIM
MA0006767OtherNHP-GROUP
MA1300709Medicaid
MA042485308OtherNETWORK HEALTH-GROUP
MA44499OtherFALLON SELECT
MAY10141OtherBCBS-GROUP
MAAA9738OtherHARVARD PILGRIM
MA6032012002OtherCIGNA
MA0103677OtherUNITED HEALTH CARE
MAG93775Medicare UPIN