Brian Beaudoin, ATC
Individual provider Active NPI Athletic Trainer · Somerville, MA
NPI 1144097296 · NPPES record last updated Jun 10, 2025
Key facts
- NPI
- 1144097296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- ATL22168 (MA)
- Practice address
- 9 Willoughby St
Somerville, MA 02143-1202 - Phone
- (774) 230-8754
- NPI assigned
- Dec 8, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATL22168 | MA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | ATL22168 | MA | Yes |
Addresses
Primary practice location
9 Willoughby St
Somerville, MA 02143-1202
Mailing address
9 Willoughby St
Somerville, MA 02143-1202
Phone (774) 230-8754
Other providers in Somerville, MA
- Tal Baz
- Castera J Bazile
- BDC Doulas LLC
- Ana Paula Bean
- Maryann Beaton
- Stephanie Becker
- Maureen Claire Beckshaw
- Lisa Ellen Beechinor
- Naama Beit Arie Shlonsky
- Kiki Jera Bekkum
All providers in Somerville, MA · Athletic Trainer in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.