Provider Demographics
NPI:1215908132
Name:BARKER, MARY KAVANAGH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAVANAGH
Last Name:BARKER
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 1:230 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5420
Mailing Address - Country:US
Mailing Address - Phone:781-431-5220
Mailing Address - Fax:781-431-5526
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5220
Practice Address - Fax:781-431-5371
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ31749OtherBLUE CROSS
MA079150OtherTUFTS
MA3185648Medicaid
MAPV595OtherHARVARD PILGRIM
MAG08016Medicare UPIN
MA3185648Medicaid