Provider Demographics
NPI:1740282094
Name:BRUNELL, WAYNE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:EDWARD
Last Name:BRUNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:872 MASSACHUSETTS AVE
Mailing Address - Street 2:STE 1-4
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3013
Mailing Address - Country:US
Mailing Address - Phone:617-234-4405
Mailing Address - Fax:
Practice Address - Street 1:872 MASSACHUSETTS AVE
Practice Address - Street 2:STE 1-4
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3013
Practice Address - Country:US
Practice Address - Phone:617-234-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1501212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry