Healthcare Provider Details

I. General information

NPI: 1710172903
Provider Name (Legal Business Name): AMY L KAHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L KESSLER M.D.

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-1020
  • Fax: 617-421-1063
Mailing address:
  • Phone: 617-421-1020
  • Fax: 617-421-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-118059
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number057384
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number250410
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: