Provider Demographics
NPI:1255579975
Name:BRIDGEWATER PEDIATRICS LLC
Entity type:Organization
Organization Name:BRIDGEWATER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:D
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-697-8116
Mailing Address - Street 1:1029 PLEASANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324
Mailing Address - Country:US
Mailing Address - Phone:508-697-8116
Mailing Address - Fax:508-697-8117
Practice Address - Street 1:1029 PLEASANT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324
Practice Address - Country:US
Practice Address - Phone:508-697-8116
Practice Address - Fax:508-697-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J06281OtherBCBS
J06281OtherBCBS