Provider Demographics
NPI:1902397748
Name:ANJELICA J CARBAJAL MD LLC
Entity Type:Organization
Organization Name:ANJELICA J CARBAJAL MD LLC
Other - Org Name:ANJELICA J CARBAJAL MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANJELICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARBAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-566-1535
Mailing Address - Street 1:1 BROOKLINE PL STE 423
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7237
Mailing Address - Country:US
Mailing Address - Phone:617-566-1535
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKLINE PL STE 423
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7237
Practice Address - Country:US
Practice Address - Phone:617-566-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245228207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty