King, Maryetta E.

King, Maryetta E. is an individual health care provider with primary practice located at 55 Fruit Street Yawkey 5-062 Massachusetts General Hospital, Boston MA 02114-2696. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. King, Maryetta E. can be contacted via phone (617) 726-3826.

Contact Information

Primary practice address
55 Fruit Street Yawkey 5-062 Massachusetts General Hospital Boston MA 02114-2696
Phone: (617) 726-3826
Fax: (617) 643-1639
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 38249 Massachusetts

Profile Details

NPI number 1962492603
LBN Legal business name King, Maryetta E.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2005
Last updated Sep 2nd, 2009 - about 16 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 1962492603 NPPES
Massachusetts Other 724773 TUFTS HEALTH PLAN
Massachusetts Other B11517 TUFTS HEALTH PLAN
Massachusetts MEDICAID 6171613 TUFTS HEALTH PLAN

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