Provider Demographics
NPI:1619965654
Name:HOLLETT, KATHRYN JOAN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOAN
Last Name:HOLLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73D WINTHROP AVE
Mailing Address - Street 2:PLAZA 114
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3716
Mailing Address - Country:US
Mailing Address - Phone:978-686-3017
Mailing Address - Fax:978-685-4280
Practice Address - Street 1:LAHEY HEALTH PRIMARY CARE, GLOUCESTER
Practice Address - Street 2:298 WASHINGTON STREET
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-283-2726
Practice Address - Fax:978-283-0840
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30915Medicare ID - Type Unspecified
G00446Medicare UPIN