Individual
BRAD DERSHEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
540 MASSACHUSETTS AVE, APT 1, BOSTON, MA 02118-1402
(773) 288-9440
Mailing address
398 COLUMBUS AVE, PMB79, BOSTON, MA 02116-6008
(773) 288-9440
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
192547-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
654839
NY
367500000X
Certified Registered Nurse Anesthetist
RN2283514
MA
Other
Enumeration date
09/11/2012
Last updated
11/14/2021
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