Provider Demographics
NPI:1265400535
Name:ARNDT, KENNETH ALFRED (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALFRED
Last Name:ARNDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-731-1600
Mailing Address - Fax:617-731-1601
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-731-1600
Practice Address - Fax:617-731-1601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA27429207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
711414OtherTUFTS
3577609-005OtherCIGNA
0000314OtherNHP
4316BIOtherHARVARD PILGRIM
2645507OtherAETNA
M07058OtherBLUE SHIELD
711414OtherTUFTS
M07058Medicare ID - Type Unspecified