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General NPI Number Information
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NPI Number | 1083744684
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Entity Type | Individual
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Provider Name | KENNETH R BRIDGES M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 65 LANDSDOWNE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4232
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Country | US
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Telephone | 617-768-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 36 GREYLOCK RD
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City | NEWTON
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State | MA
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Zip | 02465-2704
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Country | US
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Telephone | 617-768-8881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 49614
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License Number State | MA
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