Provider Demographics
NPI:1851325427
Name:DRISLANE, FRANCIS W (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:W
Last Name:DRISLANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:53 WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2133
Mailing Address - Country:US
Mailing Address - Phone:617-667-2395
Mailing Address - Fax:617-667-7919
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BETH ISRAEL DEACONESS MED CTR, KS 479
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-2395
Practice Address - Fax:617-667-7919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA542162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3004074Medicaid
MA3004074Medicaid