Individual
DR. KENNETH ROBERT DAVIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, GRB 2 RADIOLOGICAL ASSOCIATES, BOSTON, MA 02114-2696
(617) 726-8757
(617) 724-3338
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
35398
MA
2085N0700X
Neuroradiology Physician
35398
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
035398
TUFTS HEALTH PLAN
MA
05
—
2084864
—
MA
01
—
M08609
BCBS MA
MA
Enumeration date
11/09/2005
Last updated
09/11/2025
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