Provider Demographics
NPI:1598925182
Name:WILLIAMS, KYLE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:185 CAMBRIDGE ST
Mailing Address - Street 2:SIMCHES BULDING, #278
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2790
Mailing Address - Country:US
Mailing Address - Phone:617-643-3647
Mailing Address - Fax:617-643-3080
Practice Address - Street 1:185 CAMBRIDGE ST
Practice Address - Street 2:SIMCHES BULDING, #278
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2790
Practice Address - Country:US
Practice Address - Phone:617-643-3647
Practice Address - Fax:617-643-3080
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MA2574242084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program