Provider Demographics
NPI:1457418634
Name:BRITTO, VANESSA M (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:BRITTO
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 1:160 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-6824
Mailing Address - Country:US
Mailing Address - Phone:781-283-2810
Mailing Address - Fax:781-283-3693
Practice Address - Street 1:106 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-8268
Practice Address - Country:US
Practice Address - Phone:781-283-2810
Practice Address - Fax:781-283-3693
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3134709Medicaid
MAF21494Medicare UPIN
MAJ12174Medicare ID - Type UnspecifiedINDIVIDUAL