Healthcare Provider Details

I. General information

NPI: 1386892438
Provider Name (Legal Business Name): TAMARA ELIZABETH BAER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL, ADOLESCENT MEDICINE
BOSTON MA
02115-5711
US

IV. Provider business mailing address

333 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL, ADOLESCENT MEDICINE
BOSTON MA
02115-5711
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7181
  • Fax: 617-730-0184
Mailing address:
  • Phone: 617-355-7181
  • Fax: 617-730-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241385
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number250618
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: