# WALTHAM FAMILY PRACTICE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477563377
- **Authorized official:** PUNYAMURTULA S KISHORE MD (PRESIDENT)
- **Authorized official phone:** (617) 738-4640

## Contact information

- **Practice address:** 9 HOPE AVE, 1ST FLOOR, WALTHAM, MA 02453-2741
- **Practice address phone:** (781) 314-0191
- **Practice address fax:** (781) 314-0192
- **Mailing address:** 59 TEMPLE PL, STE 612, BOSTON, MA 02111-1307
- **Mailing address phone:** (617) 264-9764
- **Mailing address fax:** (617) 264-9763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 08/22/2020