Provider Demographics
NPI:1043295314
Name:CHRISTOPHER, KENNETH BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRUCE
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65 GOODNOUGH ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3140
Mailing Address - Country:US
Mailing Address - Phone:617-323-6469
Mailing Address - Fax:617-732-6392
Practice Address - Street 1:75 FRANCIS STREET MRB 418
Practice Address - Street 2:RENAL DIVISION BRIGHAM AND WOMENS HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:617-732-6392
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA208987207RN0300X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A33486Medicare ID - Type Unspecified
H53747Medicare UPIN