Provider Demographics
NPI:1043208192
Name:BROFF, MARTIN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DAVID
Last Name:BROFF
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 1:851 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1612
Mailing Address - Country:US
Mailing Address - Phone:781-331-1060
Mailing Address - Fax:781-335-9852
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1612
Practice Address - Country:US
Practice Address - Phone:781-331-1060
Practice Address - Fax:781-335-9852
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44319207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC27088OtherBLUE CROSS BLUE SHIELD
MA2088649Medicaid
MA1005OtherHARVARD PILGRIM
MA044319OtherTUFTS HEALTH CARE
A53963Medicare UPIN
C27088Medicare ID - Type Unspecified