Provider Demographics
NPI:1578528568
Name:BAER, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BAER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5123
Practice Address - Country:US
Practice Address - Phone:617-859-5250
Practice Address - Fax:617-859-5250
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA36391207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4450972-002OtherCIGNA
MA036391OtherTUFTS HEALTH PLAN
MAM09144OtherBLUE CROSS
MA2040379Medicaid
MAG215OtherHARVARD PILGRIM
MA0015412OtherNEIGHBORHOOD HEALTH PLAN
MA4450972-002OtherCIGNA
MA0015412OtherNEIGHBORHOOD HEALTH PLAN