Provider Demographics
NPI:1093705667
Name:BRAINARD, DIANA MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARINA
Last Name:BRAINARD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FND 8 INFECTIOUS DISEASE ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-9060
Practice Address - Fax:617-726-5411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA160463207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA160463OtherTUFTS HEALTH PLAN
MA2002949Medicaid
MAJ25909OtherBCBS MA
MA2002949Medicaid
H80008Medicare UPIN