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General NPI Number Information
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NPI Number | 1255579975
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Entity Type | Organization
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Legal Business Name | BRIDGEWATER PEDIATRICS LLC
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1029 PLEASANT ST SUITE 100
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City | BRIDGEWATER
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State | MA
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Zip | 02324
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Country | US
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Telephone | 508-697-8116
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Fax | 508-697-8117
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Provider Business Mailing Address
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Address Line | 1029 PLEASANT ST SUITE 100
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City | BRIDGEWATER
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State | MA
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Zip | 02324
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Country | US
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Telephone | 508-697-8116
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Fax | 508-697-8117
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | DR. FRED D KERN
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Credential | MD
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Telephone | 508-697-8116
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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 | 57747
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License Number State | MA
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