Provider Demographics
NPI:1588659445
Name:JABER, BERTRAND L (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAND
Middle Name:L
Last Name:JABER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:CCP 7064
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-7830
Mailing Address - Fax:617-562-7782
Practice Address - Street 1:11 NEVINS ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-779-6700
Practice Address - Fax:617-779-6771
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2017-12-13
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Provider Licenses
StateLicense IDTaxonomies
MA79205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19084Medicaid
G70732Medicare UPIN
MA3181308Medicare ID - Type Unspecified