Basic Information
| Provider Information | |||||||||
| NPI: | 1265417711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCKRILL GOOTKIND | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COCKRILL | ||||||||
| OtherFirstName: | BARBARA | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 375 BOYLSTON ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024456007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8573070896 | ||||||||
| FaxNumber: | 8573070899 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | BRIGHAM AND WOMEN'S HOSPITAL | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175259733 | ||||||||
| FaxNumber: | 6172646873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 76359 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | J12806 | 01 | MA | BCBS MA | OTHER | 076359 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 3093701 | 05 | MA | MEDICAID |