Provider Demographics
NPI:1649251281
Name:SHERRY, BETSY (MD)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:SHERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-499-5095
Mailing Address - Fax:617-499-5714
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 317
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-499-5095
Practice Address - Fax:617-499-5714
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72613174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99078102OtherNETWORK HEALTH
MA3068251Medicaid
MA991770OtherUNITED HEALTHCARE
MA2238515OtherAETNA
MA072613OtherTUFTS
MAB20233301OtherCIGNA
MAJ09649OtherBLUE CROSS
MA0005756OtherNHP
MA11605OtherHPHC
MA072613OtherTUFTS
MA991770OtherUNITED HEALTHCARE