Provider Demographics
NPI:1154850402
Name:BAKER-BOURGEOIS, MARC PATRICK (RN, CRNA)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:PATRICK
Last Name:BAKER-BOURGEOIS
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:MARC
Other - Middle Name:PATRICK
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:LAHEY PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805
Mailing Address - Country:US
Mailing Address - Phone:781-744-8085
Mailing Address - Fax:781-744-5433
Practice Address - Street 1:LAHEY HOSPITAL AND MEDICAL CENTER
Practice Address - Street 2:41 MALL ROAD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:781-744-8085
Practice Address - Fax:781-744-5433
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered