Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 74787 | MA |
NPI | 1063439545 |
---|---|
Provider Name | Deborah Bradley |
First Address | Beverly, MA 01915-2757 |
Second Address | Beverly, MA 01915-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3083501 | (05) | MA |
D03261 | (02) |