Provider Demographics
NPI:1649207507
Name:WAX, BARBARA SHAKER (CNM)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SHAKER
Last Name:WAX
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4042
Mailing Address - Country:US
Mailing Address - Phone:508-559-6699
Mailing Address - Fax:508-559-5073
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4042
Practice Address - Country:US
Practice Address - Phone:508-559-6699
Practice Address - Fax:508-583-4649
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124599176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN0308OtherBLUE CROSS BLUE SHIELD
0036811OtherNEIGHBORHOOD HEALTH PLAN
MAS400279457Medicare PIN
0036811OtherNEIGHBORHOOD HEALTH PLAN
CN0308OtherBLUE CROSS BLUE SHIELD