Provider Demographics
NPI:1417477589
Name:JEAN BAPTISTE, KATIA (DO)
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 LINCOLN ST STE 404
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2425
Mailing Address - Country:US
Mailing Address - Phone:617-505-1520
Mailing Address - Fax:
Practice Address - Street 1:179 LINCOLN ST STE 404
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2425
Practice Address - Country:US
Practice Address - Phone:617-505-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9084207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine