MEDICARE: KEVIN A BRAVO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	77598	MA

General Provider Information

NPI Number	:	1336137363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN A BRAVO M.D.

Provider Business Mailing Address
First Line	:	40 FISHER ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-2233
Country	:	US
Telephone Number	:	800-505-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 EVERETT AVE
Second Line	:
City	:	CHELSEA
State	:	MA
Zip	:	02150-1812
Country	:	US
Telephone Number	:	617-884-8302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	06/25/2012

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