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General NPI Number Information
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NPI Number | 1932392495
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Entity Type | Individual
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Provider Name | PETER JOSEPH KRUY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 08/19/2007
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Provider Practice Location Address
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Address Line | 411 WAVERLEY OAKS RD SUITE 133
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City | WALTHAM
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State | MA
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Zip | 02452-8448
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Country | US
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Telephone | 781-899-7546
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Fax | 781-899-9922
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Provider Business Mailing Address
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Address Line | 3 CROWN POINT RD
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City | SUDBURY
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State | MA
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Zip | 01776-1609
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Country | US
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Telephone | 978-443-1409
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Fax | 781-899-9922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 72084
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License Number State | MA
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