Healthcare Provider Details

I. General information

NPI: 1437665908
Provider Name (Legal Business Name): KUCHNIR DERMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOPE AVE STE 105
WALTHAM MA
02453-2717
US

IV. Provider business mailing address

340 MAPLE ST STE 203
MARLBOROUGH MA
01752-3200
US

V. Phone/Fax

Practice location:
  • Phone: 781-891-1540
  • Fax:
Mailing address:
  • Phone: 508-450-6141
  • Fax: 508-485-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS KUCHNIR
Title or Position: DOCTOR
Credential: MD
Phone: 508-450-6141