Healthcare Provider Details

I. General information

NPI: 1366625006
Provider Name (Legal Business Name): KIDNEY & HYPERTENSION CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KIDNEY & HYPERTENSION CLINIC, INC. 640 BOLTON ST
MARLBOROUGH MA
01752-3999
US

IV. Provider business mailing address

KIDNEY & HYPERTENSION CLINIC, INC. 640 BOLTON ST
MARLBOROUGH MA
01752-3999
US

V. Phone/Fax

Practice location:
  • Phone: 508-281-5953
  • Fax: 508-299-2343
Mailing address:
  • Phone: 508-281-5953
  • Fax: 508-299-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number154239
License Number StateMA

VIII. Authorized Official

Name: DR. HUMAIRA A MAHMUD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 508-281-5953