Provider Demographics
NPI:1891080255
Name:BOOTS, BRETA DORA (DO)
Entity Type:Individual
Prefix:DR
First Name:BRETA
Middle Name:DORA
Last Name:BOOTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:508-334-6556
Mailing Address - Fax:
Practice Address - Street 1:33 LYMAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1404
Practice Address - Country:US
Practice Address - Phone:508-898-0055
Practice Address - Fax:508-898-0035
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013986207R00000X
MA2623552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine