Provider Demographics
NPI:1457314395
Name:CLOHERTY, KERI (MD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:CLOHERTY
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066
Mailing Address - Country:US
Mailing Address - Phone:781-545-8103
Mailing Address - Fax:781-545-8117
Practice Address - Street 1:56 THE NEW DRIFTWAY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066
Practice Address - Country:US
Practice Address - Phone:781-545-8103
Practice Address - Fax:781-545-8117
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA130811OtherHARVARD PILGRIM
MA0700299OtherUNITED HEALTH CARE
MA154206OtherTUFTS
MAJ17980OtherBLUE CROSS BLUE SHIELD
MA154206OtherTUFTS
MAG53352Medicare UPIN