MEDICARE: BRAMBLEBUSH PEDIATRICS LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M15804	OTHER	MA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033179239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAMBLEBUSH PEDIATRICS LLP

Provider Business Mailing Address
First Line	:	15 BRAMBLEBUSH PARK
Second Line	:
City	:	FALMOUTH
State	:	MA
Zip	:	02540-2325
Country	:	US
Telephone Number	:	508-548-6969
Fax Number	:	508-540-2793

Provider Business Practice Location Address
First Line	:	15 BRAMBLEBUSH PARK
Second Line	:
City	:	FALMOUTH
State	:	MA
Zip	:	02540-2325
Country	:	US
Telephone Number	:	508-548-6969
Fax Number	:	508-540-2793

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	GIANNINA TIERNEY
Credential	:	M.D.
Telephone Number	:	508-548-6969

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/27/2009

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1699735811 — ELIZABETH A NARDI RNCPNP
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