Healthcare Provider Details

I. General information

NPI: 1881486181
Provider Name (Legal Business Name): BRENT CHESBROUGH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BROTHERTON WAY
AUBURN MA
01501-2684
US

IV. Provider business mailing address

5 NEPONSET ST MERCANTILE CENTER 12TH FLOOR
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-721-1199
  • Fax: 508-453-8019
Mailing address:
  • Phone: 508-852-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2355968
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: