Provider Demographics
NPI:1104825959
Name:BROMLEY, BRYANN (MD)
Entity Type:Individual
Prefix:
First Name:BRYANN
Middle Name:
Last Name:BROMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:617-724-2229
Mailing Address - Fax:617-724-3498
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:SUITE 506
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-739-0245
Practice Address - Fax:617-738-6703
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA564292085R0202X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3020304Medicaid
MA3020304Medicaid
MAJ06373Medicare PIN