Healthcare Provider Details

I. General information

NPI: 1003653064
Provider Name (Legal Business Name): SARAH W BRIGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HUNTINGTON AVE
BOSTON MA
02115-5000
US

IV. Provider business mailing address

350 OLD WESTFORD RD
CHELMSFORD MA
01824-1000
US

V. Phone/Fax

Practice location:
  • Phone: 617-373-2000
  • Fax:
Mailing address:
  • Phone: 978-770-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA102118
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: