Individual
KELLY R RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7000
Mailing address
3 WASHINGTON ST, STE 200, NORTH EASTON, MA 02356-1010
(508) 205-9630
(508) 796-2610
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1104
MA
Other
Enumeration date
12/05/2005
Last updated
02/10/2025
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