Healthcare Provider Details

I. General information

NPI: 1346409398
Provider Name (Legal Business Name): MORGAN ALYSSA BRESNICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY ST 3RD FLOOR, SUITE A
BOSTON MA
02118-2526
US

IV. Provider business mailing address

88 E NEWTON ST C515
BOSTON MA
02118-2308
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4861
  • Fax:
Mailing address:
  • Phone: 617-638-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number237499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: