Provider Demographics
NPI:1669453858
Name:MCCARTHY, KATHLEEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:MCCARTHY
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:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-1793
Mailing Address - Fax:617-726-1074
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 240
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-1793
Practice Address - Fax:617-726-1074
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA426822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0135437Medicaid
MAC23052OtherBCBS MA
MA724083OtherTUFTS HEALTH PLAN
MA724083OtherTUFTS HEALTH PLAN
MAC23052Medicare ID - Type Unspecified