Healthcare Provider Details

I. General information

NPI: 1508017260
Provider Name (Legal Business Name): KRISTIN ANNE MADENCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ANNE OJOMO

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6106
US

V. Phone/Fax

Practice location:
  • Phone: 262-366-9785
  • Fax:
Mailing address:
  • Phone: 617-525-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number266641
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number266641
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number266641
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: