Basic Information
| Provider Information | |||||||||
| NPI: | 1992755425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 10/22/2012 | ||||||||
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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 | 207V00000X | 2393731 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 15561 | NH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 32001464 | 05 | NH | MEDICAID | PREFERRED CARE | 01 | NY | MDJ358 | OTHER | AETNA | 01 | NY | 7013832 | OTHER | HEALTH NOW | 01 | NY | 000528612001 | OTHER | HEALTH NOW | 01 | NY | 000528612003 | OTHER | BCBS | 01 | NY | P020239373 | OTHER | BLUE CHOICE | 01 | NY | P010239373 | OTHER | HEALTH NOW | 01 | NY | 000528512002 | OTHER |