Provider Demographics
NPI:1396726923
Name:BERESIN, EUGENE VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:VICTOR
Last Name:BERESIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3626
Mailing Address - Country:US
Mailing Address - Phone:617-726-8471
Mailing Address - Fax:
Practice Address - Street 1:80 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3626
Practice Address - Country:US
Practice Address - Phone:617-726-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA442172084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB33588OtherBCBS MA
MA044217OtherTUFTS HEALTH PLAN
MAB33588OtherBCBS MA
MAB33588Medicare ID - Type Unspecified