Healthcare Provider Details

I. General information

NPI: 1255579975
Provider Name (Legal Business Name): BRIDGEWATER PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 PLEASANT ST SUITE 100
BRIDGEWATER MA
02324
US

IV. Provider business mailing address

1029 PLEASANT ST SUITE 100
BRIDGEWATER MA
02324
US

V. Phone/Fax

Practice location:
  • Phone: 508-697-8116
  • Fax: 508-697-8117
Mailing address:
  • Phone: 508-697-8116
  • Fax: 508-697-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57747
License Number StateMA

VIII. Authorized Official

Name: DR. FRED D KERN
Title or Position: MANAGING OWNER
Credential: MD
Phone: 508-697-8116