Provider Demographics
NPI:1477668150
Name:SEVERSON, PATRICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:SEVERSON
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 1:98 LONGWOOD AVE
Mailing Address - Street 2:APT. #4
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6665
Mailing Address - Country:US
Mailing Address - Phone:617-953-8027
Mailing Address - Fax:
Practice Address - Street 1:98 LONGWOOD AVE
Practice Address - Street 2:APT. #4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6665
Practice Address - Country:US
Practice Address - Phone:617-953-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics