Provider Demographics
NPI:1558399303
Name:WASCAVAGE, BRIAN E (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:WASCAVAGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8239
Mailing Address - Country:US
Mailing Address - Phone:508-879-0811
Mailing Address - Fax:508-879-8257
Practice Address - Street 1:42 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8239
Practice Address - Country:US
Practice Address - Phone:508-879-0811
Practice Address - Fax:508-879-8257
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002012OtherTUFTS
MA0358274Medicaid
MA480034177OtherRAILROAD
MA33944OtherHPHC
MA0358274Medicaid
MAY7098601Medicare PIN