Healthcare Provider Details

I. General information

NPI: 1043295314
Provider Name (Legal Business Name): KENNETH BRUCE CHRISTOPHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET MRB 418 RENAL DIVISION BRIGHAM AND WOMENS HOSPITAL
BOSTON MA
02115-6110
US

IV. Provider business mailing address

65 GOODNOUGH ROAD
CHESTNUT HILL MA
02467-3140
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax: 617-732-6392
Mailing address:
  • Phone: 617-323-6469
  • Fax: 617-732-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number208987
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number208987
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number208987
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: