Healthcare Provider Details

I. General information

NPI: 1407866619
Provider Name (Legal Business Name): JEFFREY D BAXTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LINCOLN ST
WORCESTER MA
01605-1906
US

IV. Provider business mailing address

10 MECHANIC ST SUITE 302
WORCESTER MA
01608-2420
US

V. Phone/Fax

Practice location:
  • Phone: 508-831-0045
  • Fax: 508-831-0074
Mailing address:
  • Phone: 508-792-5400
  • Fax: 508-831-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number157945
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number157945
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: