Provider Demographics
NPI:1902853625
Name:BRYER, HALDON P (MD)
Entity Type:Individual
Prefix:
First Name:HALDON
Middle Name:P
Last Name:BRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6750
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03802-6750
Mailing Address - Country:US
Mailing Address - Phone:800-208-7069
Mailing Address - Fax:610-956-0009
Practice Address - Street 1:200 UNICORN PARK DR STE 402
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3342
Practice Address - Country:US
Practice Address - Phone:603-943-5580
Practice Address - Fax:603-717-7445
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1537422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0168521Medicaid
MAA33906Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
MAH60315Medicare UPIN