Provider Demographics
NPI:1518607290
Name:D'AMORE, BRIAN R
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:D'AMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LORETTE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3307
Mailing Address - Country:US
Mailing Address - Phone:508-785-5250
Mailing Address - Fax:
Practice Address - Street 1:11 LORETTE ST APT 3
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3307
Practice Address - Country:US
Practice Address - Phone:508-785-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program