Provider Demographics
NPI:1871610923
Name:BRAINTREE FAMILY PHYSICIAN INC
Entity type:Organization
Organization Name:BRAINTREE FAMILY PHYSICIAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BRAINTREE FAMILY PYSIC
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LENTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:781-848-1555
Mailing Address - Street 1:382 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-848-1555
Mailing Address - Fax:781-848-2312
Practice Address - Street 1:382 GROVE STREET
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-848-1555
Practice Address - Fax:781-848-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71650207Q00000X
MA27809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9762957Medicaid