Basic Information
| Provider Information | |||||||||
| NPI: | 1154850402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER-BOURGEOIS | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN, SRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BOURGEOIS | ||||||||
| OtherFirstName: | MARC | ||||||||
| OtherMiddleName: | PATRICK | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | LAHEY PROVIDER ENROLLMENT DEPARTMENT | ||||||||
| Address2: | 41 MALL ROAD | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448085 | ||||||||
| FaxNumber: | 7817445433 | ||||||||
| Practice Location | |||||||||
| Address1: | LAHEY HOSPITAL AND MEDICAL CENTER | ||||||||
| Address2: | 41 MALL ROAD | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448085 | ||||||||
| FaxNumber: | 7817445433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2017 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN2283549 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.