Individual
DR. BONNIE TERESA MACKOOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
50 STANIFORD ST, SUITE 200, BOSTON, MA 02114-2517
(617) 726-2914
(617) 724-2135
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
76647
MA
207N00000X
Dermatology Physician
G81270
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3107621
—
MA
01
—
729619
TUFTS HEALTH PLAN
MA
01
—
J13548
BCBS MA
MA
Enumeration date
02/03/2006
Last updated
11/30/2012
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