Healthcare Provider Details

I. General information

NPI: 1669595187
Provider Name (Legal Business Name): AMITHA KNIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST
BOSTON MA
02111-1526
US

IV. Provider business mailing address

8 SILVEY PL
SOMERVILLE MA
02143-2444
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228600
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: