Healthcare Provider Details

I. General information

NPI: 1912017328
Provider Name (Legal Business Name): MARIA E KANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIMOCK COMM.HEALTH CENTER 55 DIMOCK STREET
ROXBURY MA
02119
US

IV. Provider business mailing address

10 SALEM RD
WELLESLEY MA
02481-1254
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-8800
  • Fax:
Mailing address:
  • Phone: 617-442-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31312
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: