Provider Demographics
NPI:1922078930
Name:BAILEN, LAURENCE SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:SCOTT
Last Name:BAILEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:GREEN BUILDING, SUITE 368
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-969-1227
Mailing Address - Fax:617-969-2676
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:GREEN BUILDING, SUITE 368
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-969-1227
Practice Address - Fax:617-969-2676
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA81467207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Not Answered207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3192563Medicaid
MA3192563Medicaid
MAG89515Medicare UPIN