Provider Demographics
NPI:1184004038
Name:MEDFORD, KATHERINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:MEDFORD
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 1:616 BOSTON POST ROAD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776
Mailing Address - Country:US
Mailing Address - Phone:978-443-6005
Mailing Address - Fax:978-443-8429
Practice Address - Street 1:616 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776
Practice Address - Country:US
Practice Address - Phone:978-443-6005
Practice Address - Fax:978-443-8429
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263976208000000X
MA273907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics