Provider Demographics
NPI:1417916875
Name:BATBOUTA, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BATBOUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-885-9737
Mailing Address - Fax:508-885-6139
Practice Address - Street 1:407 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562
Practice Address - Country:US
Practice Address - Phone:508-885-9737
Practice Address - Fax:508-885-6139
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0141038Medicaid
043058466OtherHEALTHCARE VALUE MANAGMEN
934922OtherFIRST HEALTH
4034909OtherAETNA US HEALTHCARE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
26851OtherHEALTHY START
784246OtherMVP HEALTH CARE
9900035OtherFALLON COMMUNITY HEALTH P
E47011OtherBLUE SHIELD HMO BLUE
0141038OtherMEDICAID WELFARE
E47011OtherBLUE CARE ELECT
E47011OtherBLUE SHIELD INDEMNITY
042472266OtherTHREE RIVERS
5020732OtherCIGNA HEALTH PLAN
AA1193OtherHARVARD PILGRIM HEALTHCAR
26851OtherCHILDRENS MEDICAL SECURIT
E47011OtherMEDICARE B
934922OtherFIRST HEALTH
AA1193OtherHARVARD PILGRIM HEALTHCAR