MEDICARE: DR. SCOTT BARRY GOETZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	49375	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	701157	OTHER	MA	TUFTS HEALTH PLAN
2	E05740	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1730163668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT BARRY GOETZ MD

Provider Business Mailing Address
First Line	:	5 PLIMPTON RD
Second Line	:
City	:	SHARON
State	:	MA
Zip	:	02067-1627
Country	:	US
Telephone Number	:	781-784-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 DORCHESTER AVE
Second Line	:	4 SOUTH
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5615
Country	:	US
Telephone Number	:	617-296-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	01/15/2009

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