Provider Demographics
NPI:1649207051
Name:BARNETT, REGINALD ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:ANDRE
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WELLESLEY PARK
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2134
Mailing Address - Country:US
Mailing Address - Phone:617-436-2562
Mailing Address - Fax:
Practice Address - Street 1:745 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1941
Practice Address - Country:US
Practice Address - Phone:617-364-0222
Practice Address - Fax:617-364-3470
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA059479OtherSECURE HORIZON
MAHPHCOther625287
MAJ09247OtherHMO BLUE
MA3056597Medicaid
MA305697Medicaid
MD625287OtherTUFTS TOTAL HEALTH
MAJ09247OtherBLUE SHIELD
MA625287OtherTUFTS ASSOCHEALTH PLAN
MAP00089350OtherRAILROAD /MEDICARE
J09247OtherBS MASTER PLUS
J09247OtherBS MASTER PLUS
MD625287OtherTUFTS TOTAL HEALTH