Healthcare Provider Details

I. General information

NPI: 1437147071
Provider Name (Legal Business Name): EDWARD M. KOWALOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE SUITE 4100
CAMBRIDGE MA
02138-1040
US

IV. Provider business mailing address

319 CABOT ST
NEWTONVILLE MA
02460-2255
US

V. Phone/Fax

Practice location:
  • Phone: 617-864-8822
  • Fax: 617-547-5367
Mailing address:
  • Phone: 617-527-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44238
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number44238
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: