Provider Demographics
NPI:1407819287
Name:ANGUS, BARBARA EDITH (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:EDITH
Last Name:ANGUS
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 1:500 CONGRESS ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-471-3411
Mailing Address - Fax:617-471-3584
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-471-3411
Practice Address - Fax:617-471-3584
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209420208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0135950Medicaid
MA0135950Medicaid