Provider Demographics
NPI:1164954186
Name:SUPPAN, CATHERINE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ANNE
Last Name:SUPPAN
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 1:68B ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-1864
Mailing Address - Country:US
Mailing Address - Phone:508-833-0269
Mailing Address - Fax:
Practice Address - Street 1:179 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1714
Practice Address - Country:US
Practice Address - Phone:508-362-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10959205-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics