Individual
KENNETH GERARD BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
19 FRIENDSHIP ST, FAMILY PHYSICIANS OF NEWPORT, SUITE 130, NEWPORT, RI 02840-2272
(401) 845-2113
Mailing address
275 BROADWAY, NHCC MEDICAL ASSOCIATES, UNIT 2, NEWPORT, RI 02840-2612
(401) 845-1473
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
158732
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
KB 91558
—
RI
Enumeration date
11/27/2005
Last updated
07/11/2013
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