Healthcare Provider Details

I. General information

NPI: 1134689763
Provider Name (Legal Business Name): BREYEN COFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE
BOSTON MA
02118-2905
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FLR 2
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number1022177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: