Healthcare Provider Details

I. General information

NPI: 1790807865
Provider Name (Legal Business Name): KRISTEN M PERRAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL MALLORY 416
BOSTON MA
02118-2908
US

IV. Provider business mailing address

36 QUEENSBERRY ST APT# 4
BOSTON MA
02215-5246
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5022
  • Fax:
Mailing address:
  • Phone: 617-414-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number231209
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: