Provider Demographics
NPI:1588602809
Name:DOMOTO, KATHERINE K (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:DOMOTO
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 1:128 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3049
Mailing Address - Country:US
Mailing Address - Phone:781-830-8890
Mailing Address - Fax:
Practice Address - Street 1:3 RANDOLF STREET
Practice Address - Street 2:MASS HOSPITAL SCHOOL
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-830-8890
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine