Basic Information
| Provider Information | |||||||||
| NPI: | 1427248442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAIR | ||||||||
| FirstName: | BRONWYN | ||||||||
| MiddleName: | EILEEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3572 BRODHEAD RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MONACA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150613101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247286284 | ||||||||
| FaxNumber: | 7247287416 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 DUTCH RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150099727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247734567 | ||||||||
| FaxNumber: | 7247289729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35.096261 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD433656 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000000273789 | 01 | PA | UNISON | OTHER | NA2052612 | 01 | PA | HIGHMARK BLUE SHIELD NUMBER | OTHER | 102183030002 | 05 | PA | MEDICAID | 251343987005 | 01 | PA | HEALTH NET | OTHER |