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General NPI Number Information
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NPI Number | 1306864483
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Entity Type | Individual
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Provider Name | CHARLES R BRIDGES MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 106 PINE ST
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City | AUBURNDALE
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State | MA
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Zip | 02466-1308
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Country | US
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Telephone | 610-247-2986
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Fax | 704-372-1249
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Provider Business Mailing Address
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Address Line | 106 PINE ST
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City | AUBURNDALE
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State | MA
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Zip | 02466-1308
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Country | US
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Telephone | 610-247-2986
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Fax | 704-372-1249
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2011-01426
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 2011-01426
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD031335E
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License Number State | PA
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