Basic Information
Provider Information | |||||||||
NPI: | 1275565335 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | O'NEIL | ||||||||
FirstName: | BARBARA | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 147 MILK ST | ||||||||
Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021094806 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6175598374 | ||||||||
FaxNumber: | 6174213487 | ||||||||
Practice Location | |||||||||
Address1: | 1611 CAMBRIDGE ST | ||||||||
Address2: |   | ||||||||
City: | CAMBRIDGE | ||||||||
State: | MA | ||||||||
PostalCode: | 021384302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6176615500 | ||||||||
FaxNumber: | 6176615460 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51296 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0014922 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 051296 | 01 | MA | TUFTS | OTHER | 3199118 | 05 | MA |   | MEDICAID | J02577 | 01 | MA | BLUE CROSS | OTHER | M277 | 01 | MA | HARVARD PILGRIM | OTHER |