Healthcare Provider Details

I. General information

NPI: 1912970203
Provider Name (Legal Business Name): BARBRA MCDONAGH BLAIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET COX 5
BOSTON MA
02114
US

IV. Provider business mailing address

55 FRUIT STREET COX 5
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3906
  • Fax: 617-726-7653
Mailing address:
  • Phone: 617-726-3906
  • Fax: 617-726-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number213278
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: