Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 81039 | MA |
NPI | 1003867144 |
---|---|
Provider Name | Kevin Bresnahan |
First Address | Woburn, MA 01801-1728 |
Second Address | Hyannis, MA 02601-5230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 30/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3143716 | (05) | MA |
F80197 | (02) | MA |
J31488 | BLUE SHIELD (01) | MA |