Provider Demographics
NPI:1760470058
Name:BRAVER, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BRAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:RADIOLOGY, BRIGHAM & WOMEN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-6295
Mailing Address - Fax:617-264-5151
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY, BRIGHAM & WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6295
Practice Address - Fax:617-535-7333
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA372022085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2057398Medicaid
MAM09556OtherBLUE CROSS BLUE SHIELD
MA037202OtherTUFTS HEALTH CARE
MAM09556OtherBLUE CROSS BLUE SHIELD
MAM09556Medicare ID - Type Unspecified