Provider Demographics
NPI:1427156496
Name:TROCKMAN, BARBARA JO (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JO
Last Name:TROCKMAN
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 1:22 GROVE PL
Mailing Address - Street 2:#15
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3866
Mailing Address - Country:US
Mailing Address - Phone:781-721-7262
Mailing Address - Fax:
Practice Address - Street 1:49 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2156
Practice Address - Country:US
Practice Address - Phone:617-390-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3014223Medicaid
MAJ05628Medicare ID - Type Unspecified