Provider Demographics
NPI:1326036880
Name:WARE, KATHLEEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:G
Last Name:WARE
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 1:22 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1506
Mailing Address - Country:US
Mailing Address - Phone:508-588-6200
Mailing Address - Fax:508-588-6211
Practice Address - Street 1:22 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1506
Practice Address - Country:US
Practice Address - Phone:508-588-6200
Practice Address - Fax:508-588-6211
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3175995Medicaid
MAOTH0000Medicare UPIN