Basic Information
Provider Information
NPI: 1235372905
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARIL
FirstName: SAVANNAH
MiddleName: EDEN GREYROSE
NamePrefix: DR.
NameSuffix:  
Credential: MD, MSC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GREYROSE
OtherFirstName: SAVANNAH
OtherMiddleName: EDEN
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: MD, MSC
OtherLastNameType: 1
Mailing Information
Address1: 243 CHARLES ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021143002
CountryCode: US
TelephoneNumber: 6175237900
FaxNumber:  
Practice Location
Address1: 243 CHARLES ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021143002
CountryCode: US
TelephoneNumber: 6175237900
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2009
LastUpdateDate: 07/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XMT195272MAY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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