Provider Demographics
NPI:1033109715
Name:MARTIEN, KATHERINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:MARTIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARTIEN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:781-860-1700
Mailing Address - Fax:781-860-1766
Practice Address - Street 1:1 MAGUIRE RD
Practice Address - Street 2:LURIE CENTER FOR AUTISM
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-3114
Practice Address - Country:US
Practice Address - Phone:781-860-1700
Practice Address - Fax:781-860-1766
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54511208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3058654Medicaid
MA054511OtherTUFTS HEALTH PLAN
MAJ09444OtherBCBS MA
MAJ09444Medicare PIN
MAJ09444OtherBCBS MA