Brackett, Ethan S

Brackett, Ethan S is an individual health care provider with primary practice located at 1340 Boylston St , Boston MA 02215-4302. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Brackett, Ethan S can be contacted via phone (617) 247-7555.

Contact Information

Primary practice address
1340 Boylston St Boston MA 02215-4302
Phone: (617) 247-7555
Fax: (617) 421-9871
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 209141 Massachusetts

Profile Details

NPI number 1912970633
LBN Legal business name Brackett, Ethan S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Sep 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912970633 NPPES
Massachusetts MEDICAID 0145670

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