Individual
TATIANA BAKAEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
1 HOPPIN STREET, COROWEST SUITE 202, PROVIDENCE, RI 02903
(401) 444-6551
(401) 444-6587
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
272919
MA
2084N0400X
Neurology Physician
Primary
MD16734
RI
Other
Enumeration date
06/25/2014
Last updated
07/02/2019
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