Provider Demographics
NPI:1316162407
Name:BRAGG, MASON ALEXANDER (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:ALEXANDER
Last Name:BRAGG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:151 OCEAN RD
Mailing Address - Street 2:APT #14
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-1355
Mailing Address - Country:US
Mailing Address - Phone:917-544-0210
Mailing Address - Fax:401-444-5088
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-8450
Practice Address - Fax:401-444-5088
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00952207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine