Provider Demographics
NPI:1023358835
Name:ZWICKER, KELLEY ANN (MSC, MD, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:ANN
Last Name:ZWICKER
Suffix:
Gender:F
Credentials:MSC, MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 FREE
Mailing Address - Street 2:131 FREEMAN STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-755-1533
Mailing Address - Fax:
Practice Address - Street 1:131 FREEMAN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3590
Practice Address - Country:US
Practice Address - Phone:617-755-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ28686208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery