Provider Demographics
NPI:1952716177
Name:KURAYEV, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KURAYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:OBRUCHNIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8371 116TH ST
Mailing Address - Street 2:APT.6E
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3448
Mailing Address - Country:US
Mailing Address - Phone:718-849-0262
Mailing Address - Fax:
Practice Address - Street 1:260 TREMONT STREET, BIEWEND BLD.,
Practice Address - Street 2:14TH FLOOR, DERMATOLOGY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:347-755-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268549207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952716177Medicaid