Healthcare Provider Details

I. General information

NPI: 1710968599
Provider Name (Legal Business Name): HOWARD BAUCHNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL DOWLING 3 SOUTH CHILD HEALTH FOUNDATION OF BOSTON
BOSTON MA
02118-2908
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL DIVISION OF PEDIATRICS DOWLING 3 SOUTH
BOSTON MA
02118-2908
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5170
  • Fax: 617-414-3803
Mailing address:
  • Phone: 617-414-5170
  • Fax: 617-414-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50728
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: