Provider Demographics
NPI:1700844735
Name:LABOW, BRIAN IAN
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:IAN
Last Name:LABOW
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:HUN 158
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-4964
Mailing Address - Fax:617-738-1657
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:HUN 158
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-4964
Practice Address - Fax:617-738-1657
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1509102086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3157253Medicaid
MAA21991Medicare ID - Type Unspecified
MAG39274Medicare UPIN
RX2508Medicare PIN