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Individual

DR. KIMBERLY RUSSO DITTLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1153 CENTRE ST, BOSTON, MA 02130-3446
(617) 983-7700
(617) 983-7724
Mailing address
1153 CENTRE ST, BOSTON, MA 02130-3446
(617) 983-7700
(617) 983-7724

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-113760
IL
207P00000X
Emergency Medicine Physician
054658
GA
207P00000X
Emergency Medicine Physician
Primary
236721
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036113760
IL
Enumeration date
07/17/2006
Last updated
03/29/2011
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