Provider Demographics
NPI:1841238318
Name:BAE, JANE S (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:S
Last Name:BAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
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Mailing Address - Street 1:1 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5599
Mailing Address - Country:US
Mailing Address - Phone:781-493-3530
Mailing Address - Fax:781-493-3806
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-493-3530
Practice Address - Fax:781-493-3806
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210721207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468956OtherTUFTS HEALTH PLAN
MA0032966OtherNEIGHBORHOOD HEALTH PLAN
MA3447341OtherCIGNA
MA2093961Medicaid
MAJ27418OtherBLUE CROSS
MAAA15065OtherHARVARD PILGRIM
MASX2691Medicare PIN
MAJ27418OtherBLUE CROSS