Provider Demographics
NPI:1831134105
Name:RADDEN, NANCY FAIRBANKS (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:FAIRBANKS
Last Name:RADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GROSSMAN DR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4997
Mailing Address - Country:US
Mailing Address - Phone:781-849-2400
Mailing Address - Fax:781-849-2238
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-2400
Practice Address - Fax:781-849-2238
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27432OtherBLUE CROSS
MA0032974OtherNEIGHBORHOOD HEALTH
MAAA12193OtherHARVARD PILGRIM
MA469233OtherTUFTS
MA2059941Medicaid
MA469233OtherTUFTS
MAI12835Medicare UPIN