Healthcare Provider Details

I. General information

NPI: 1225654148
Provider Name (Legal Business Name): MARIA CHAUNCY BRYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE. ENDERS 140
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE ENDERS 140
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6117
  • Fax:
Mailing address:
  • Phone: 617-355-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP05090
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number1015192
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1015192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: