Provider Demographics
NPI:1952350969
Name:BASS, JEFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:BASS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:25 BOYLSTON ST
Mailing Address - Street 2:UNIT 312
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1715
Mailing Address - Country:US
Mailing Address - Phone:617-307-3200
Mailing Address - Fax:617-307-3201
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:UNIT 312
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:617-307-3200
Practice Address - Fax:617-307-3201
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-06-05
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Provider Licenses
StateLicense IDTaxonomies
MA53774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6185142Medicaid
MA6185142Medicaid
MAJ04017Medicare PIN