Provider Demographics
NPI:1427025444
Name:BASS, JOEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:L
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3501
Mailing Address - Country:US
Mailing Address - Phone:781-449-0184
Mailing Address - Fax:
Practice Address - Street 1:NEWTON-WELLESLEY HOSPITAL
Practice Address - Street 2:2014 WASHINGTON STREET
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6565
Practice Address - Fax:617-243-6981
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE02041Medicare UPIN