Provider Demographics
NPI:1982806451
Name:KERBEL, BRENDA
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:KERBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:KERBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17 LAURUS LN
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3138
Mailing Address - Country:US
Mailing Address - Phone:617-332-7757
Mailing Address - Fax:
Practice Address - Street 1:548 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4122
Practice Address - Country:US
Practice Address - Phone:617-923-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA454202080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA45420OtherMASS LICENSE