Provider Demographics
NPI:1366625006
Name:KIDNEY & HYPERTENSION CLINIC, INC
Entity Type:Organization
Organization Name:KIDNEY & HYPERTENSION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMAIRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-281-5953
Mailing Address - Street 1:KIDNEY & HYPERTENSION CLINIC, INC.
Mailing Address - Street 2:640 BOLTON ST
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3999
Mailing Address - Country:US
Mailing Address - Phone:508-281-5953
Mailing Address - Fax:508-299-2343
Practice Address - Street 1:KIDNEY & HYPERTENSION CLINIC, INC.
Practice Address - Street 2:640 BOLTON ST
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3999
Practice Address - Country:US
Practice Address - Phone:508-281-5953
Practice Address - Fax:508-299-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154239207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA33542OtherMEDICARE INDIVIDUAL PIN
MAA33542OtherMEDICARE INDIVIDUAL PIN