Provider Demographics
NPI:1154360246
Name:KRYDER, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:KRYDER
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 1:72 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1617
Mailing Address - Country:US
Mailing Address - Phone:781-431-2424
Mailing Address - Fax:
Practice Address - Street 1:20 WILLIAM ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-4103
Practice Address - Country:US
Practice Address - Phone:781-431-2424
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine