Provider Demographics
NPI:1538132923
Name:MAGNANI, BARBARAJEAN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:BARBARAJEAN
Middle Name:
Last Name:MAGNANI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SAINT STEPHEN ST
Mailing Address - Street 2:#9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4560
Mailing Address - Country:US
Mailing Address - Phone:617-638-7818
Mailing Address - Fax:617-638-4556
Practice Address - Street 1:670 ALBANY ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2518
Practice Address - Country:US
Practice Address - Phone:617-414-5314
Practice Address - Fax:617-414-5315
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73496207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3165141Medicaid
NH30204452Medicaid
MAG44274Medicare UPIN
MA3165141Medicaid