Healthcare Provider Details

I. General information

NPI: 1568463495
Provider Name (Legal Business Name): ROBERT JOSEPH BARBOZA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST ANESTHESIA OFFICE
BOSTON MA
02114-3002
US

IV. Provider business mailing address

350 GRANGE PARK
BRIDGEWATER MA
02324-2392
US

V. Phone/Fax

Practice location:
  • Phone: 617-523-7900
  • Fax:
Mailing address:
  • Phone: 508-697-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number136876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: