Provider Demographics
NPI:1891711495
Name:NEWTON-WELLESLEY OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:NEWTON-WELLESLEY OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARYLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-332-2345
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 768
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-332-2345
Mailing Address - Fax:617-332-0435
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 768
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-332-2345
Practice Address - Fax:617-332-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15234Medicare ID - Type UnspecifiedGROUP MEDICARE