Healthcare Provider Details

I. General information

NPI: 1588077051
Provider Name (Legal Business Name): KILLIAN JOHN HURLEY MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE BOSTON MEDICAL CENTER
BOSTON MA
02118
US

IV. Provider business mailing address

43 RUSSELL AVE,. DRUMCONDRA
DUBLIN DUBLIN
3
IE

V. Phone/Fax

Practice location:
  • Phone: 617-638-4860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number260499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: