Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2676 | MA |
NPI | 1710915426 |
---|---|
Provider Name | Dr. Bradford Eichwald |
First Address | Deerfield, MA 01342-9758 |
Second Address | Hadley, MA 01035-9511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3136481 | AETNA (01) | MA |
665294 | ACN (01) | MA |
U 90187 | (02) | MA |
Y36874 | BLUE CROSS BLUE SHIELD (01) | MA |