Provider Demographics
NPI:1043277924
Name:BRIGHAM, KATHRYN SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:SUSAN
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:SUSAN
Other - Last Name:BRINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-643-1201
Mailing Address - Fax:617-724-0581
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW-6D
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-1201
Practice Address - Fax:617-724-0581
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229958208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics