Provider Demographics
NPI:1346446168
Name:ARTHUR R BREGOLI JR MD PC
Entity Type:Organization
Organization Name:ARTHUR R BREGOLI JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:BREGOLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:781-849-7330
Mailing Address - Street 1:400 WASHINGTON ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4729
Mailing Address - Country:US
Mailing Address - Phone:781-849-7330
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON ST
Practice Address - Street 2:SUITE 402
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4729
Practice Address - Country:US
Practice Address - Phone:781-849-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77050261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3104982Medicaid
MA3104982Medicaid
MAF47767Medicare UPIN