Provider Demographics
NPI:1124009592
Name:WHITEHOUSE, BRIAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:WHITEHOUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:460 TOTTEN POND RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1906
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9950
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:STE 209
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-370-8003
Practice Address - Fax:508-879-4502
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78301208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA078301OtherTUFTS
MA3118321Medicaid
MAJ30156OtherBCBS
MA801716OtherHPHC
MA078301OtherTUFTS
MAJ30156OtherBCBS