MEDICARE: DR. JONATHAN NOAH BASS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	46670	MA
2	2084P0804X	Child & Adolescent Psychiatry Physician	46670	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JO3946	OTHER	MA	BLUE CROSS BLUE SHIELD
2	706514	OTHER	MA	TUFTS ASSOCIATED HEALTH

General Provider Information

NPI Number	:	1164597035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN NOAH BASS M.D.

Provider Business Mailing Address
First Line	:	91 ROBINWOOD AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-2112
Country	:	US
Telephone Number	:	781-449-8342
Fax Number	:	781-449-5984

Provider Business Practice Location Address
First Line	:	91 ROBINWOOD AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-2112
Country	:	US
Telephone Number	:	781-449-8342
Fax Number	:	781-449-5984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2006
Last Update Date	:	09/11/2025

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