Basic Information
| Provider Information | |||||||||
| NPI: | 1568463495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARBOZA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 GRANGE PARK | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023242392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086975876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 243 CHARLES ST | ||||||||
| Address2: | ANESTHESIA OFFICE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175237900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 03/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 136876 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 12442929 | 01 | MA | CAQH ID | OTHER |