Provider Demographics
NPI:1134327745
Name:ROSENFIELD, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ROSENFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:GRB 800
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-1935
Mailing Address - Fax:617-726-3971
Practice Address - Street 1:55 FRUIT ST # 800
Practice Address - Street 2:MAILSTOP 843
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1935
Practice Address - Fax:617-726-3971
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79142207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08828OtherBCBS MA
MA3047610Medicaid
MA713099OtherTUFTS HEALTH PLAN
MAE15237Medicare UPIN
MAJ08828Medicare ID - Type Unspecified