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General NPI Number Information
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NPI Number | 1063215036
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Entity Type | Individual
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Provider Name | JHONY BAISSARY MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 330 MOUNT AUBURN ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5502
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Country | US
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Telephone | 671-492-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 1999 CIRCLE DR APT 414
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City | CLEVELAND
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State | OH
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Zip | 44106-3671
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Country | US
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Telephone | 216-233-2007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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