Basic Information
| Provider Information | |||||||||
| NPI: | 1588639108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUNNING | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 PARKMAN ST | ||||||||
| Address2: | BULFINCH MEDICAL GROUP, WANG 535 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177246610 | ||||||||
| FaxNumber: | 6177246632 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 PARKMAN ST | ||||||||
| Address2: | BULFINCH MEDICAL GROUP, WANG 535 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177246610 | ||||||||
| FaxNumber: | 6177246632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 160037 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 160037 | 01 | MA | TUFTS | OTHER | 3196933 | 05 | MA | MEDICAID | PV888 | 01 | MA | HARVARD PILGRIM | OTHER | J21344 | 01 | MA | BLUE CROSS | OTHER |