Provider Demographics
NPI:1073818092
Name:JUDY BRASIER DO, LLC
Entity Type:Organization
Organization Name:JUDY BRASIER DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-579-3452
Mailing Address - Street 1:4 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1761
Mailing Address - Country:US
Mailing Address - Phone:508-579-3452
Mailing Address - Fax:
Practice Address - Street 1:200 PROVIDENCE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1881
Practice Address - Country:US
Practice Address - Phone:781-461-4543
Practice Address - Fax:781-326-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226380261QM1300X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1548299530Medicare PIN
MA1548299530Medicare Oscar/Certification
MA1548299530Medicare NSC