Provider Demographics
NPI:1235114265
Name:MCFADDEN, BRIAN L (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 INDIAN HILL ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-2018
Mailing Address - Country:US
Mailing Address - Phone:978-430-0866
Mailing Address - Fax:
Practice Address - Street 1:55 INDIAN HILL ST
Practice Address - Street 2:
Practice Address - City:WEST NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01985-2018
Practice Address - Country:US
Practice Address - Phone:978-430-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN