Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 79158 | MA |
NPI | 1003824202 |
---|---|
Provider Name | Mr. Matthew Philip Brewer |
First Address | Melrose, MA 02176 |
Second Address | Melrose, MA 02176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9787119 | (05) | MA |
F78893 | (02) |