Provider Demographics
NPI:1699853820
Name:BAJUSZ, THERESIA M (MD)
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:M
Last Name:BAJUSZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE CHARLES SOUTH
Mailing Address - Street 2:8E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-262-0252
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON STREET
Practice Address - Street 2:7 EAST
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-734-2202
Practice Address - Fax:617-264-9690
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32695207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
M08592OtherBCBS
E03272Medicare UPIN
MAM08592Medicare ID - Type Unspecified