Provider Demographics
NPI:1801863196
Name:BREGOLI, ARTHUR RALPH JR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:RALPH
Last Name:BREGOLI
Suffix:JR
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 1:116 MONATIQUOT AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3927
Mailing Address - Country:US
Mailing Address - Phone:781-848-7242
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4729
Practice Address - Country:US
Practice Address - Phone:781-849-7330
Practice Address - Fax:781-356-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-05
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3104982Medicaid
MA3104982Medicaid
MAF47767Medicare UPIN