Healthcare Provider Details

I. General information

NPI: 1700462223
Provider Name (Legal Business Name): BRANDON EMILIO BERTOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6106
US

IV. Provider business mailing address

221 LONGWOOD AVE RF 386-C
BOSTON MA
02115-5817
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5775
  • Fax:
Mailing address:
  • Phone: 617-732-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1018399
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: