Provider Demographics
NPI:1669446902
Name:GURIAN, BENNETT SHEPPE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:SHEPPE
Last Name:GURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MASON TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2779
Mailing Address - Country:US
Mailing Address - Phone:617-566-4045
Mailing Address - Fax:
Practice Address - Street 1:328 MASON TER
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2779
Practice Address - Country:US
Practice Address - Phone:617-566-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA296362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0451201OtherPTAN
C0451201OtherPTAN