Davis, Kenneth Robert

Davis, Kenneth Robert is an individual health care provider with primary practice located at 55 Fruit St Grb 2 Radiological Associates, Boston MA 02114-2696. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Nuclear Medicine, Allopathic & Osteopathic Physicians / Neuroradiology. Allopathic & Osteopathic Physicians / Nuclear Medicine is his primary health care specialty. Davis, Kenneth Robert can be contacted via phone (617) 726-8757.

Contact Information

Primary practice address
55 Fruit St Grb 2 Radiological Associates Boston MA 02114-2696
Phone: (617) 726-8757
Fax: (617) 724-3338
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Medicine 207U00000X 35398 Massachusetts
Allopathic & Osteopathic Physicians / Neuroradiology 2085N0700X 35398 Massachusetts

Profile Details

NPI number 1669453486
LBN Legal business name Davis, Kenneth Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669453486 NPPES
Massachusetts Other 035398 TUFTS HEALTH PLAN
Massachusetts Other M08609 TUFTS HEALTH PLAN
Massachusetts MEDICAID 2084864 TUFTS HEALTH PLAN

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