Organization
PREVENTIVE MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PUNYAMURTULA KISHORE M.D. (DIRECTOR)
(617) 383-6567
Entity
Organization
Contact information
Practice address
11 KENT ST, BROOKLINE, MA 02445-7901
(617) 383-6405
Mailing address
11 KENT ST, BROOKLINE, MA 02445-7901
(617) 383-6405
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9772898
—
MA
Enumeration date
05/10/2006
Last updated
05/22/2008
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