Provider Demographics
NPI:1861629107
Name:EATON, BREE RUPPERT (MD)
Entity Type:Individual
Prefix:
First Name:BREE
Middle Name:RUPPERT
Last Name:EATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:NICOLE
Other - Last Name:RUPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:63 MOUNT VERNON ST
Mailing Address - Street 2:APT #52
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-1325
Mailing Address - Country:US
Mailing Address - Phone:404-644-6268
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:LUNDER BUILDING, LL2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:404-644-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004011207R00000X
MA2593522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine