Provider Demographics
NPI:1871541045
Name:GIRARD, KERRY M (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:M
Last Name:GIRARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3117
Mailing Address - Country:US
Mailing Address - Phone:508-697-3677
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:545 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3117
Practice Address - Country:US
Practice Address - Phone:508-697-3677
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3172287Medicaid
MAA22897Medicare PIN