Provider Demographics
NPI:1083844211
Name:EISENMENGER, KATHERINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:C
Last Name:EISENMENGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 BEACON ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2013
Mailing Address - Country:US
Mailing Address - Phone:617-353-9610
Mailing Address - Fax:617-353-9609
Practice Address - Street 1:648 BEACON ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2013
Practice Address - Country:US
Practice Address - Phone:617-353-9610
Practice Address - Fax:617-353-9609
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA802932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry