Individual
CALEB BOSLER KORNGOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-4630
Mailing address
PSC 305 BOX 2108, APO, AP 96218-0022
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
122623
CA
2084P0800X
Psychiatry Physician
Primary
17541
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2009
Last updated
07/07/2021
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