Provider Demographics
NPI:1407234131
Name:OLIVEIRA, KATELYN (DO)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:480 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3729
Practice Address - Country:US
Practice Address - Phone:508-973-9180
Practice Address - Fax:508-973-9185
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RILP033112084N0400X
MA2820242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology