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1639169758

NPI Code Detail

MEDICARE: CLIFFORD MARK BRESLOW M.D.

MEDICARE: CLIFFORD MARK BRESLOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	77175	MA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	77175	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42723	OTHER	MA	FALLON
2	275188	OTHER	MA	HARVARD PILGRIM
3	077175	OTHER	MA	TUFTS HEALTH PLAN
4	275188	OTHER	MA	HARVARD FIRST SENIORITY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639169758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFFORD MARK BRESLOW M.D.

Provider Business Mailing Address
First Line	:	163 LIBBEY PKWY
Second Line	:	SUITE 301
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3101
Country	:	US
Telephone Number	:	781-337-4224
Fax Number	:	781-335-0429

Provider Business Practice Location Address
First Line	:	55 FOGG RD
Second Line	:
City	:	SOUTH WEYMOUTH
State	:	MA
Zip	:	02190-2432
Country	:	US
Telephone Number	:	781-340-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/03/2008

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Directions to “ CLIFFORD MARK BRESLOW M.D.” Practice Location

Language	Start Address	Practice Location

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