Provider Demographics
NPI:1184746257
Name:BRACKLEY, MARGUERITE M (MD)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:M
Last Name:BRACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DARTMOUTH ST
Mailing Address - Street 2:APARTMENT #2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5969
Mailing Address - Country:US
Mailing Address - Phone:508-683-6645
Mailing Address - Fax:
Practice Address - Street 1:100 BOSTON SCIENTIFIC WAY
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1234
Practice Address - Country:US
Practice Address - Phone:508-683-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine