Provider Demographics
NPI:1447241518
Name:YUTANGCO, KATHERINE L (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:YUTANGCO
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 1:370 FAUNCE CORNER ROAD
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:1030 PRESIDENT AVENUE, SUITE 1001
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-730-3000
Practice Address - Fax:508-730-3071
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10484207R00000X
MA208109208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9023138Medicaid
RI408877OtherBLUECHIP
RI29885-2OtherBC/BS
RI408877OtherBLUECHIP
RI29885-2OtherBC/BS