Provider Demographics
NPI:1528221702
Name:BRUCE KASTER MD
Entity Type:Organization
Organization Name:BRUCE KASTER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-964-8200
Mailing Address - Street 1:77 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3111
Mailing Address - Country:US
Mailing Address - Phone:617-964-8200
Mailing Address - Fax:617-969-0996
Practice Address - Street 1:10 LANGLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:617-964-8200
Practice Address - Fax:617-969-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA762712084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0013522Medicare PIN
MAF97272Medicare UPIN