Provider Demographics
NPI:1043354715
Name:KURTZ, ELLEN (NP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1513
Mailing Address - Country:US
Mailing Address - Phone:508-660-5900
Mailing Address - Fax:508-668-9152
Practice Address - Street 1:1 RESEARCH DR
Practice Address - Street 2:SUITE 120C
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3922
Practice Address - Country:US
Practice Address - Phone:508-660-5900
Practice Address - Fax:508-668-9152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99821261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service