Healthcare Provider Details

I. General information

NPI: 1992742191
Provider Name (Legal Business Name): KIM L THORNTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2D AVENUE BOSTON IVF - THE WALTHAM CENTER
WALTHAM MA
02451
US

IV. Provider business mailing address

130 2D AVENUE BOSTON IVF - THE WALTHAM CENTER
WALTHAM MA
02451
US

V. Phone/Fax

Practice location:
  • Phone: 781-434-6500
  • Fax: 781-434-6501
Mailing address:
  • Phone: 781-434-6500
  • Fax: 781-434-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number153109
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD10471
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number029664
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35.052652
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number153109
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD10471
License Number StateRI
# 7
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number029664
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35.052652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: