Provider Demographics
NPI:1477190775
Name:BAZILE, FINETTE
Entity Type:Individual
Prefix:
First Name:FINETTE
Middle Name:
Last Name:BAZILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LANCASTER ST STE 341D
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4397
Mailing Address - Country:US
Mailing Address - Phone:978-401-2990
Mailing Address - Fax:978-227-5005
Practice Address - Street 1:435 LANCASTER ST STE 341D
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4397
Practice Address - Country:US
Practice Address - Phone:978-401-2990
Practice Address - Fax:978-227-5005
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1023488491OtherMASSHEALTH