Healthcare Provider Details

I. General information

NPI: 1598202558
Provider Name (Legal Business Name): KIDNEY CARE AND TRANSPLANT SERVICES OF NEW ENGLAND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 MAIN ST
SPRINGFIELD MA
01104-3566
US

IV. Provider business mailing address

PO BOX 366
LUDLOW MA
01056-0366
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-0010
  • Fax:
Mailing address:
  • Phone: 413-733-0010
  • Fax: 413-930-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY MULHERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 413-733-0010