Basic Information
| Provider Information | |||||||||
| NPI: | 1194700955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598053 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 WALL ST | ||||||||
| Address2: | HARVARD VANGUARD MEDICAL ASSOCIATES | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018034758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812212500 | ||||||||
| FaxNumber: | 7812212510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 46096 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0146889 | 05 | MA | MEDICAID | 0015951 | 01 | MA | NEIGHBOR HOOD HEALTH | OTHER | 6563095 | 01 | MA | CIGNA | OTHER | B11714 | 01 | MA | BLUE CROSS | OTHER | 0092149 | 01 | MA | AETNA | OTHER | 12-04563 | 01 | MA | UNITED HEALTHCARE | OTHER | AA8201 | 01 | MA | HARVARD PILGRIM HEALTH | OTHER | 046096 | 01 | MA | TUFTS | OTHER |