Provider Demographics
NPI:1194703637
Name:GARBER, JUDY ELLEN (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELLEN
Last Name:GARBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WARD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1331
Mailing Address - Country:US
Mailing Address - Phone:617-965-9419
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:SM 209
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-5770
Practice Address - Fax:617-632-2649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52007207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA052007OtherTUFTS
MA30-04188OtherUNITED HEALTH CARE
MA2063580OtherAETNA US HEALTHCARE
MA36843OtherFALLON COMMUNITY HEALTH
MA6182939OtherCIGNA
MA3161617Medicaid
MAE27205DFOtherHPHC (DFCI)
MA2063580OtherAETNA US HEALTHCARE
MAJ09155Medicare ID - Type Unspecified