Provider Demographics
NPI:1083819502
Name:AHLERT, KAREN L (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:AHLERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:WALP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-868-7456
Mailing Address - Fax:617-868-9243
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 407
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-868-7456
Practice Address - Fax:617-868-9243
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-231744208600000X
MA253631208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094173AMedicaid
MA110094173AMedicaid