Provider Demographics
NPI:1669453999
Name:KLEINERMAN, JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:KLEINERMAN
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 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-824-5865
Mailing Address - Fax:508-823-9108
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-824-5865
Practice Address - Fax:508-823-9108
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79043207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3000330OtherUNITED HEALTH PLANS
MAJ31588OtherBLUE SHIELD OF MASS
MA3207498Medicaid
MA768799OtherTUFTS HEALTH PLAN
MA65872OtherHARVARD PILGRIM HEATLH CA
MAQX8019Medicare PIN
MAJ31588OtherBLUE SHIELD OF MASS
MA768799OtherTUFTS HEALTH PLAN