Provider Demographics
NPI:1891180626
Name:BATES, REBECCA N (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:BATES
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Gender:F
Credentials:MD
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Mailing Address - Street 1:BMC PROVIDER ENROLLMENT OFFICE
Mailing Address - Street 2:960 MASSACHUSETTS AVE,.2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4302
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE
Practice Address - Street 2:CROSSTOWN 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-7399
Practice Address - Fax:617-247-3460
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2024-04-04
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Provider Licenses
StateLicense IDTaxonomies
MA281312208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00620586Medicaid