Healthcare Provider Details

I. General information

NPI: 1790795441
Provider Name (Legal Business Name): GAYATHRI KRISHNA KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH ST
MEDFIELD MA
02052-1654
US

IV. Provider business mailing address

50 NORTH ST
MEDFIELD MA
02052-1654
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-1519
  • Fax:
Mailing address:
  • Phone: 508-359-1519
  • Fax: 508-359-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28701
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-01777
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number294067
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: