MEDICARE: DR. BRIAN DAVID MARRIOTT 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	207Q00000X	Family Medicine Physician	223018	MA

General Provider Information

NPI Number	:	1770577926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN DAVID MARRIOTT M.D.

Provider Business Mailing Address
First Line	:	244 WOOD ST
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6426
Country	:	US
Telephone Number	:	781-981-7080
Fax Number	:	781-981-2165

Provider Business Practice Location Address
First Line	:	244 WOOD ST
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6426
Country	:	US
Telephone Number	:	781-981-7080
Fax Number	:	781-981-2165

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	04/06/2022

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