Provider Demographics
NPI:1417944141
Name:TREADWAY, KATHARINE KENNEDY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:KENNEDY
Last Name:TREADWAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 615 INTERNAL MEDICINE ASSOCIATES TEAM 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-2674
Practice Address - Fax:617-724-0656
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA47706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA044706OtherTUFTS HEALTH PLAN
MAE05495OtherBCBS MA
MA0138053Medicaid
MAB05495Medicare ID - Type Unspecified
MA044706OtherTUFTS HEALTH PLAN