Healthcare Provider Details

I. General information

NPI: 1508281528
Provider Name (Legal Business Name): RAQUEL BAILOTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WAVERLY ST
FRAMINGHAM MA
01702-7079
US

IV. Provider business mailing address

2000 CENTURY DR
WORCESTER MA
01606-1256
US

V. Phone/Fax

Practice location:
  • Phone: 508-370-0113
  • Fax: 508-370-3637
Mailing address:
  • Phone: 508-532-7318
  • Fax: 508-853-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2290342
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: