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General NPI Number Information
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NPI Number | 1366625006
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Entity Type | Organization
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Legal Business Name | KIDNEY & HYPERTENSION CLINIC, INC
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | KIDNEY & HYPERTENSION CLINIC, INC. 640 BOLTON ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3999
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Country | US
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Telephone | 508-281-5953
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Fax | 508-299-2343
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Provider Business Mailing Address
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Address Line | KIDNEY & HYPERTENSION CLINIC, INC. 640 BOLTON ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3999
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Country | US
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Telephone | 508-281-5953
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Fax | 508-299-2343
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HUMAIRA A MAHMUD
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Credential | M.D.
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Telephone | 508-281-5953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 154239
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License Number State | MA
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