Individual
AISLING BASTIBLE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1353 DORCHESTER AVE, DORCHESTER, MA 02122-2932
(617) 288-3230
(617) 825-4972
Mailing address
38C UNION AVE, JAMAICA PLAIN, MA 02130-2616
(617) 524-8217
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
159377
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3199941
—
MA
Enumeration date
03/23/2006
Last updated
07/08/2007
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