Provider Demographics
NPI:1679519474
Name:NOBEL, KENNETH W (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:NOBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1011
Mailing Address - Country:US
Mailing Address - Phone:617-363-8522
Mailing Address - Fax:617-363-8929
Practice Address - Street 1:1200 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131-1011
Practice Address - Country:US
Practice Address - Phone:617-363-8522
Practice Address - Fax:617-363-8929
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33610207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry