Provider Demographics
NPI:1902103385
Name:KINGSBURY PRIMARY CARE PC
Entity Type:Organization
Organization Name:KINGSBURY PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:KAMEL
Authorized Official - Last Name:ELAMINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-585-5518
Mailing Address - Street 1:11 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1231
Mailing Address - Country:US
Mailing Address - Phone:781-585-5518
Mailing Address - Fax:781-585-5510
Practice Address - Street 1:11 TREMONT ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1231
Practice Address - Country:US
Practice Address - Phone:781-585-5518
Practice Address - Fax:781-585-5510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSBURY PRIMARY CARE,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-19
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty