Individual
KENNETH R DEVELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
92 HIGH ST, SUITE 32, MEDFORD, MA 02155-3850
(781) 395-5250
Mailing address
92 HIGH ST, SUITE 32, MEDFORD, MA 02155-3850
(781) 395-5250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
40819
MA
Other
Enumeration date
06/05/2006
Last updated
08/16/2011
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