Provider Demographics
NPI:1558351635
Name:HANNIGAN, KATY-ANN E (DO)
Entity Type:Individual
Prefix:
First Name:KATY-ANN
Middle Name:E
Last Name:HANNIGAN
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 1:250 GREEN ST
Mailing Address - Street 2:STE 110
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1377
Mailing Address - Country:US
Mailing Address - Phone:978-630-5030
Mailing Address - Fax:
Practice Address - Street 1:250 GREEN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1396
Practice Address - Country:US
Practice Address - Phone:978-630-5030
Practice Address - Fax:855-248-9859
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219096208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2018918Medicaid
MA2018918Medicaid
H45828Medicare UPIN
MAA35926Medicare ID - Type Unspecified