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Provider Information for 1063402535

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ROLAND R BRUSSEAU MD

Gender: MALE

Individual NPI: 1063402535

Calendar   Last Updated:  2009-05-20
  Certification Date: 

Details

Name Value
NPI 1063402535
Enumeration Date 2005-10-26
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address CHILDREN'S HOSPITAL ANESTHESIA DEPARTMENT 300 LONGWOOD AVENUE
BOSTON, MA 02115
United States

Phone: 617-355-2114 | Fax: 617-729-8923
View Map External Link
Primary Practice Address CHILDREN'S HOSPITAL ANESTHESIA DEPARTMENT 300 LONGWOOD AVENUE
BOSTON, MA 02115
United States

Phone: 617-355-2114 | Fax: 617-729-8923
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BCBS OF MA MA J29254
Other TUFTS HEALTH PLAN MA 478748
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207L00000X - Anesthesiology MA 225840
No 207RC0200X - Internal Medicine Critical Care Medicine MA 225840