Organization
WALTHAM FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PUNYAMURTULA S KISHORE MD (PRESIDENT)
(617) 738-4640
Entity
Organization
Contact information
Practice address
9 HOPE AVE, 1ST FLOOR, WALTHAM, MA 02453-2741
(781) 314-0191
(781) 314-0192
Mailing address
59 TEMPLE PL, STE 612, BOSTON, MA 02111-1307
(617) 264-9764
(617) 264-9763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/09/2006
Last updated
08/22/2020
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