Provider Demographics
NPI:1336308717
Name:JOAN C BREEN MC PLLC
Entity Type:Organization
Organization Name:JOAN C BREEN MC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-372-8000
Mailing Address - Street 1:145 WARD HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-6928
Mailing Address - Country:US
Mailing Address - Phone:978-372-8000
Mailing Address - Fax:
Practice Address - Street 1:145 WARD HILL AVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-6928
Practice Address - Country:US
Practice Address - Phone:978-372-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA759742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9791388Medicaid
MAJ42412OtherBLUE CROSS BLUE SHIELD
MA075974OtherTUFTS ASSOCIATED HEALTH PLAN
MA8102057OtherCIGNA
MAF69344OtherHARVARD PILGRIM HEALTHCARE
MA5328227OtherAETNA US HEALTHCARE
MAJ42412OtherBLUE CROSS BLUE SHIELD