Provider Demographics
NPI:1568496651
Name:SANDERS, KATHY M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-0895
Mailing Address - Fax:617-724-0308
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WHT 1 ACUTE PSYCHIATRY SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-0895
Practice Address - Fax:617-724-0308
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA706092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048080Medicaid
MA070609OtherTUFTS HEALTH PLAN
MAJ09203OtherBCBS MA
E28420Medicare UPIN
MA070609OtherTUFTS HEALTH PLAN