Provider Demographics
NPI:1669461810
Name:WAXMAN, AARON B (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:B
Last Name:WAXMAN
Suffix:
Gender:M
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 1:75 FRANCIS STREET
Mailing Address - Street 2:PBB CLINICS-3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-525-9733
Mailing Address - Fax:617-264-6873
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:PBB CLINICS-3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-525-9733
Practice Address - Fax:617-264-6873
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77804207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3204049Medicaid
MA077804OtherTUFTS HEALTH PLAN
MAJ21830OtherBCBS MA
MAA30411Medicare ID - Type Unspecified
MA3204049Medicaid