Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 208987 | MA |
N | 111NI0900X | Internist | 208987 | MA |
N | 207RC0200X | Critical Care Medicine | 208987 | MA |
Y | 207RN0300X | Nephrologist | 208987 | MA |
NPI | 1043295314 |
---|---|
Provider Name | Kenneth Bruce Christopher |
First Address | Chestnut Hill, MA 02467-3140 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 06/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H53747 | (02) |