Provider Demographics
NPI:1568643807
Name:KURT C FABRICK MD MPH
Entity Type:Organization
Organization Name:KURT C FABRICK MD MPH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FABRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:617-738-6400
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-381-6400
Mailing Address - Fax:617-738-6466
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:STE 4E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-738-6400
Practice Address - Fax:617-738-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6164246007OtherCIGNA
MA696326OtherHARVARD PILGRIM
MAM17877OtherMASS BLUECROSS
MA4646060OtherAETNA NON-HOM
MA2645642OtherAETNA HMO
MA3135691Medicaid
MA760121OtherTUFTS
MA=========OtherUHC
MA696326OtherHARVARD PILGRIM
MA6164246007OtherCIGNA