Healthcare Provider Details

I. General information

NPI: 1932367620
Provider Name (Legal Business Name): ALICE KIDDER BUKHMAN M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE TOLAND KIDDER

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-676-8278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number250977
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: