Healthcare Provider Details

I. General information

NPI: 1629498290
Provider Name (Legal Business Name): HABEN F KEFELLA M.D., M.H.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HARRISON AVE
BOSTON MA
02118-2371
US

IV. Provider business mailing address

720 HARRISON AVE
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5423
  • Fax: 617-638-6744
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number260090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: