Individual
BRAEDEN W. CONLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 443-7552
(774) 441-6086
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5962
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110120329A
—
MA
Enumeration date
07/29/2016
Last updated
10/28/2020
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