Healthcare Provider Details

I. General information

NPI: 1265545370
Provider Name (Legal Business Name): KENNETH M HURVITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NEVINS ST #505
BRIGHTON MA
02135-3514
US

IV. Provider business mailing address

11 NEVINS ST #505
BRIGHTON MA
02135-3514
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-9210
  • Fax: 617-782-8565
Mailing address:
  • Phone: 617-782-9210
  • Fax: 617-782-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: