Healthcare Provider Details

I. General information

NPI: 1669679148
Provider Name (Legal Business Name): OTILIA BRAESCU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BILLERICA RD OB/GYN
CHELMSFORD MA
01824-3604
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-6200
  • Fax: 978-244-6665
Mailing address:
  • Phone: 617-421-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number231808
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: