Provider Demographics
NPI:1639176662
Name:SCANLAN, KAREN DIETRICH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DIETRICH
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-762-5586
Mailing Address - Fax:781-762-0634
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-5586
Practice Address - Fax:781-762-0634
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2010-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA81177207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3140091Medicaid
MAG06389Medicare UPIN
MA3140091Medicaid