MEDICARE: DR. MARTIN PAUL KAFKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	56419	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	JO2422	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538157458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN PAUL KAFKA M.D.

Provider Business Mailing Address
First Line	:	80 BEAUMONT AVE
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-2330
Country	:	US
Telephone Number	:	617-964-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 MILL ST
Second Line	:	SUITE #306
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4784
Country	:	US
Telephone Number	:	781-643-0610
Fax Number	:	781-643-1609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	11/03/2010

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