Provider Demographics
NPI:1881684967
Name:BAUTE, LISA B (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:BAUTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS. GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-2229
Mailing Address - Fax:617-724-3498
Practice Address - Street 1:55 FRUIT ST YAW 4F
Practice Address - Street 2:VINCENT OB/GYN SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-2229
Practice Address - Fax:617-724-3498
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-09-05
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Provider Licenses
StateLicense IDTaxonomies
MA217620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2022915Medicaid
MA468545OtherTUFTS HEALTH PLAN
MAJ26788OtherBCBS OF MA
H30679Medicare UPIN
MAA36219Medicare ID - Type Unspecified