Individual
DR. KURT CHARLES FABRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
1 CLINTON PATH, UNIT #1, BROOKLINE, MA 02445-4207
(617) 640-1402
(617) 383-5732
Mailing address
1 CLINTON PATH, UNIT #1, BROOKLINE, MA 02445-4207
(617) 640-1402
(617) 383-5732
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
79759
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-3581957
TAX ID
MA
05
—
3135691
—
MA
01
—
79759
MA STATE LICENSE NUMBER
MA
Enumeration date
05/22/2006
Last updated
04/01/2011
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