Provider Demographics
NPI:1770577926
Name:MARRIOTT, BRIAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:MARRIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6426
Mailing Address - Country:US
Mailing Address - Phone:781-981-7080
Mailing Address - Fax:781-981-2165
Practice Address - Street 1:244 WOOD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6426
Practice Address - Country:US
Practice Address - Phone:781-981-7080
Practice Address - Fax:781-981-2165
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA A37982Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID NUMB