Healthcare Provider Details

I. General information

NPI: 1134176928
Provider Name (Legal Business Name): BRADFORD S GERMAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N MAIN ST
ATTLEBORO MA
02703-1752
US

IV. Provider business mailing address

303 N MAIN ST
ATTLEBORO MA
02703-1752
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-3960
  • Fax: 508-226-8552
Mailing address:
  • Phone: 508-222-3960
  • Fax: 508-226-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55351
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: