Provider Demographics
NPI:1760884688
Name:ABBOTT, BRIAN PATRICK (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TILESTON ST
Mailing Address - Street 2:APT 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1950
Mailing Address - Country:US
Mailing Address - Phone:617-435-0597
Mailing Address - Fax:
Practice Address - Street 1:17 TILESTON ST
Practice Address - Street 2:APT 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-1950
Practice Address - Country:US
Practice Address - Phone:617-435-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical