Provider Demographics
NPI:1114973443
Name:COURTNEY, KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:COURTNEY
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:PO BOX 11218
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02211-1218
Mailing Address - Country:US
Mailing Address - Phone:617-636-5319
Mailing Address - Fax:
Practice Address - Street 1:PRATT PEDIATRIC ASSOCIATES, INC
Practice Address - Street 2:750 WASHINGTON STREET-NEMC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02211-0001
Practice Address - Country:US
Practice Address - Phone:617-636-5319
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist