Healthcare Provider Details

I. General information

NPI: 1114915709
Provider Name (Legal Business Name): BARRY N. KAYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 NORWOOD ST
EVERETT MA
02149-2709
US

IV. Provider business mailing address

84 LONG AVE
BELMONT MA
02478-2964
US

V. Phone/Fax

Practice location:
  • Phone: 617-394-7500
  • Fax:
Mailing address:
  • Phone: 617-484-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47974
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: