Provider Demographics
NPI:1336136159
Name:OLSON, KATHRYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:L
Last Name:OLSON
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 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-452-1331
Mailing Address - Fax:978-452-8331
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 401
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-452-1331
Practice Address - Fax:978-452-8331
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003666OtherNHP-MA
20342OtherFALLON COMMUNITY HP
MAJ30075OtherBCBS-MA
MA9738720Medicaid
7024906OtherCIGNA
3312OtherHEALTHSOURCE
075177OtherTUFTS
3736202OtherAETNA/US HEALTHCARE HMO
5137245OtherAETNA/US HEALTHCARE
130020OtherHPHC
979922OtherNETWORK HEALTH
5137245OtherAETNA/US HEALTHCARE
7024906OtherCIGNA