Organization
JOHN L BRUSCH MD,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN L BRUSCH M.D., P.C. (PHYSICIAN)
(617) 665-1511
Entity
Organization
Contact information
Practice address
1493 CAMBRIDGE ST, ROOM 779, CAMBRIDGE, MA 02139-1047
(617) 665-1511
Mailing address
1493 CAMBRIDGE ST, ROOM 779, CAMBRIDGE, MA 02139-1047
(617) 665-1511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9728589
—
MA
01
—
M12752
BLUE SHIELD
MA
Enumeration date
07/17/2007
Last updated
07/17/2007
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