Provider Demographics
NPI:1447245006
Name:KERN, FRED D (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:D
Last Name:KERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3020321Medicaid
E01880Medicare UPIN
MA3020321Medicaid