Healthcare Provider Details

I. General information

NPI: 1295982007
Provider Name (Legal Business Name): KRISTIN MARIE CORAPI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST SUITE 302, ROOM 312
BOSTON MA
02114-2783
US

IV. Provider business mailing address

165 CAMBRIDGE ST SUITE 302, ROOM 312
BOSTON MA
02114-2783
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number253708
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number253708
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: