Provider Demographics
NPI:1194700955
Name:HANSON, BRIDGET G (MD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:G
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2500
Practice Address - Fax:781-221-2510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA46096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0146889Medicaid
MA0015951OtherNEIGHBOR HOOD HEALTH
MA6563095OtherCIGNA
MAB11714OtherBLUE CROSS
MA0092149OtherAETNA
MA12-04563OtherUNITED HEALTHCARE
MAAA8201OtherHARVARD PILGRIM HEALTH
MA046096OtherTUFTS
MA046096OtherTUFTS