Provider Demographics
NPI:1821075961
Name:BATTISTA, BRIAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:BATTISTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1221 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1561
Mailing Address - Country:US
Mailing Address - Phone:781-340-1702
Mailing Address - Fax:781-340-0931
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1561
Practice Address - Country:US
Practice Address - Phone:781-340-1702
Practice Address - Fax:781-340-0931
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA49391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA703685OtherTUFTS HEALTH PLAN
MAJ01015OtherBLUE CROSS BLUE SHIELD
MA65192OtherHARVARD PILGRIM
MA0040503OtherNEIGHBORHOOD HEALTH PLAN
MA0161144Medicaid
MA703685OtherTUFTS HEALTH PLAN
MA0161144Medicaid