Provider Demographics
NPI:1215183256
Name:MAR, BRENTON GARRETT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:GARRETT
Last Name:MAR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 TREMONT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3180
Mailing Address - Country:US
Mailing Address - Phone:312-560-4488
Mailing Address - Fax:857-233-4292
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:312-560-4488
Practice Address - Fax:857-233-4292
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246128208000000X
MA2386092080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics