MEDICARE: YARMOUTH FAMILY PRACTICE, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207QA0401X	Addiction Medicine (Family Medicine) Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1568470052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YARMOUTH FAMILY PRACTICE, PC

Provider Business Mailing Address
First Line	:	59 TEMPLE PL
Second Line	:	SUITE 612
City	:	BOSTON
State	:	MA
Zip	:	02111-1307
Country	:	US
Telephone Number	:	617-264-9764
Fax Number	:	617-264-9763

Provider Business Practice Location Address
First Line	:	303 ROUTE 28
Second Line	:
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-4661
Country	:	US
Telephone Number	:	508-771-0911
Fax Number	:	509-771-0025

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PUNYAMURTULA S KISHORE
Credential	:	MD
Telephone Number	:	617-738-4640

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/11/2025

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