Healthcare Provider Details

I. General information

NPI: 1073506796
Provider Name (Legal Business Name): JOHN R KANIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2005
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WALPOLE ST
NORWOOD MA
02062-3315
US

IV. Provider business mailing address

104 WILSHIRE PARK
NEEDHAM MA
02492-3700
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-6834
  • Fax: 781-769-7008
Mailing address:
  • Phone: 781-269-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37140
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: