Provider Demographics
NPI:1558781260
Name:DANNHEIM DREW, KATELYN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:C
Last Name:DANNHEIM DREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:DANNHEIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY, WARREN BUILDING 225
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-643-0800
Mailing Address - Fax:617-726-7474
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA269758207ZH0000X, 207ZP0213X, 207ZP0101X
RIMD16702207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology