Provider Demographics
NPI:1659333714
Name:MAJERES, KEVIN DARYL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DARYL
Last Name:MAJERES
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 1:22 HILLIARD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4972
Mailing Address - Country:US
Mailing Address - Phone:857-259-2086
Mailing Address - Fax:866-371-3238
Practice Address - Street 1:22 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4972
Practice Address - Country:US
Practice Address - Phone:857-259-2086
Practice Address - Fax:866-371-3238
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL58162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175040801Medicaid
TX175040801Medicaid
TXMA08D8272Medicare ID - Type Unspecified