MEDICARE: DR. BRIAN E. HERRICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	241953	MA

General Provider Information

NPI Number	:	1952357055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN E. HERRICK M.D.

Provider Business Mailing Address
First Line	:	230 HIGHLAND AVE
Second Line	:	IT 6TH FLOOR
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1408
Country	:	US
Telephone Number	:	617-591-4770
Fax Number	:	617-591-4778

Provider Business Practice Location Address
First Line	:	337 SOMERVILLE AVE
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-2914
Country	:	US
Telephone Number	:	617-591-4770
Fax Number	:	617-591-4778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	11/18/2011

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