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General NPI Number Information
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NPI Number | 1194700955
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Entity Type | Individual
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Provider Name | BRIDGET G HANSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20 WALL ST HARVARD VANGUARD MEDICAL ASSOCIATES
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City | BURLINGTON
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State | MA
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Zip | 01803-4758
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Country | US
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Telephone | 781-221-2500
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Fax | 781-221-2510
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Provider Business Mailing Address
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Address Line | 147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
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City | BOSTON
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State | MA
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Zip | 02109-4806
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Country | US
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Telephone | 617-559-8053
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Fax | 617-421-3487
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 46096
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License Number State | MA
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