Provider Demographics
NPI:1689660284
Name:BREDVIK, BRIAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:BREDVIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-7367
Mailing Address - Fax:413-737-2686
Practice Address - Street 1:3640 MAIN ST.
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-7367
Practice Address - Fax:413-737-2686
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152892OtherCONNECTICARE
MA010152892MA01OtherCT BLUE SHIELD
MA20689OtherHEALTH NEW ENGLAND
MA152892OtherTUFTS
MA180032298OtherRAILROAD MEDICARE
MA0115328OtherAETNA GROUP ID
MAJ18467OtherMASS BLUE SHIELD
MA0804380OtherUNITED HEALTH CARE
MA151584OtherHARVARD PILGRIM
MA1541871003OtherCIGNA HEALTHCARE
MAP1686817OtherOXFORD HEALTH PLANS
MA151584OtherHARVARD PILGRIM
MA180032298OtherRAILROAD MEDICARE