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General NPI Number Information
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NPI Number | 1205953049
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Entity Type | Individual
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Provider Name | PRUDENCE BAXTER MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 40 THORNDIKE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02141-1715
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Country | US
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Telephone | 617-547-3407
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Fax | 617-252-0099
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Provider Business Mailing Address
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Address Line | 25 BREWSTER ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2203
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Country | US
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Telephone | 617-547-3407
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Fax | 617-252-0099
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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 | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | 47174
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 47174
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License Number State | MA
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