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NPI Code Detail

MEDICARE: AIMEE C. KOBJACK MD

MEDICARE: AIMEE C. KOBJACK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician282879MA

General Provider Information

NPI Number : 1104358001
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIMEE C. KOBJACK MD
Provider Business Mailing Address
First Line : PO BOX 415348
Second Line :
City : BOSTON
State : MA
Zip : 02241-5348
Country : US
Telephone Number : 800-225-8885
Fax Number : 508-334-8105
Provider Business Practice Location Address
First Line : 198 AYER RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1163
Country : US
Telephone Number : 978-456-2355
Fax Number : 978-456-2356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2017
Last Update Date : 10/24/2020

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