Healthcare Provider Details

I. General information

NPI: 1548522980
Provider Name (Legal Business Name): SAMANTHA J. BARAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DIMOCK ST
BOSTON MA
02119-1208
US

IV. Provider business mailing address

55 DIMOCK ST
BOSTON MA
02119-1029
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-8800
  • Fax: 617-442-5840
Mailing address:
  • Phone: 617-442-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262771
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: