Provider Demographics
NPI:1497738355
Name:BRAVEMAN, FERNE R (MD)
Entity Type:Individual
Prefix:
First Name:FERNE
Middle Name:R
Last Name:BRAVEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FERNE
Other - Middle Name:B
Other - Last Name:SERVARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-638-6950
Practice Address - Fax:617-638-6966
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55545207L00000X
CT028763207L00000X, 207LP2900X
CAG151372207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001287631Medicaid
A58310Medicare UPIN
CT050000474Medicare ID - Type Unspecified
CT72000000Medicare ID - Type Unspecified