Provider Demographics
NPI:1871668640
Name:KENNETH M REED MD PC
Entity Type:Organization
Organization Name:KENNETH M REED MD PC
Other - Org Name:KENNETH M REED MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-6764
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:B1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-472-6764
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:B1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-472-6764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49076207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3013791Medicaid
MA1295775732OtherINDIVIDUAL
MA1295775732OtherINDIVIDUAL
MAJ02349Medicare ID - Type UnspecifiedINDIVIDUAL
MAB74248Medicare UPIN