Healthcare Provider Details

I. General information

NPI: 1821654559
Provider Name (Legal Business Name): ADAM RUSSELL KRONISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

233 PLEASANT ST # B310
WATERTOWN MA
02472-2457
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD478630
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number1023604
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: