Healthcare Provider Details

I. General information

NPI: 1801876735
Provider Name (Legal Business Name): GWENDOLYN KANE-WANGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 VARICK HILL RD
WABAN MA
02468-1331
US

IV. Provider business mailing address

26 VARICK HILL RD
WABAN MA
02468-1331
US

V. Phone/Fax

Practice location:
  • Phone: 617-797-5278
  • Fax:
Mailing address:
  • Phone: 617-797-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number75535
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75535
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: