Provider Demographics
NPI:1407904865
Name:BRADLEY, ANNE L (RD- CDE)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:L
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RD- CDE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:39 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7971
Mailing Address - Country:US
Mailing Address - Phone:978-372-8883
Mailing Address - Fax:978-372-8883
Practice Address - Street 1:70 EAST ST
Practice Address - Street 2:G-4
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4597
Practice Address - Country:US
Practice Address - Phone:978-687-0156
Practice Address - Fax:978-685-5793
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA133133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABRMT0281Medicare UPIN