Healthcare Provider Details

I. General information

NPI: 1972164937
Provider Name (Legal Business Name): KUCHNIR REALTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 APEX DR STE 103A
MARLBOROUGH MA
01752-1860
US

IV. Provider business mailing address

15 FOXHILL DR
SOUTHBOROUGH MA
01772-1778
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-7779
  • Fax: 508-485-7769
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN KUCHNIR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-330-1163