Provider Demographics
NPI:1881689859
Name:GEORGE L BARRETT, M.D., P.C.
Entity Type:Organization
Organization Name:GEORGE L BARRETT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:617-696-0082
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-0082
Mailing Address - Fax:617-696-1933
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-0082
Practice Address - Fax:617-696-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3076890Medicaid
MAJ10980Medicare ID - Type Unspecified
MA3076890Medicaid