Provider Demographics
NPI:1114038585
Name:ANDERSON, KRISTIN KORE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KORE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST, CW 10
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL, NEWBORN MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02117-3310
Mailing Address - Country:US
Mailing Address - Phone:617-732-6030
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST, CW 10
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL, NEWBORN MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02117-3310
Practice Address - Country:US
Practice Address - Phone:617-732-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOTH000Medicare UPIN