Provider Demographics
NPI:1336140425
Name:MERRA, KATHERINE MARY (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:MERRA
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 1:2 POND PARK RD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4309
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-331-0300
Practice Address - Street 1:2 POND PARK RD.
Practice Address - Street 2:STE. 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4309
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-331-0300
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74730207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016866OtherNHP
MA3079902Medicaid
719345OtherTUFTS HEALTH PLAN
719345OtherTUFTS MEDICARE PREFERRED
042297845OtherHCVM/FIRST HEATLH/COVENTY
900324OtherUNITED HEALTH CARE
J11386OtherBLUE SHIELD
042297845OtherTRICARE
042297845OtherPHCS/MULTI-PLAN
B20458702OtherCIGNA HEALTH CARE
000233OtherONE HEALTH
042297845OtherGREAT WEST HEALTH CARE
80314OtherGIC/UNICARE
53309OtherFALLON
171346OtherHARVARD PILGRIM HEALTH
3681368OtherAETNA
J11386OtherBLUE SHIELD
719345OtherTUFTS MEDICARE PREFERRED