Provider Demographics
NPI:1679545339
Name:FANUCCI, KAREN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:FANUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-2123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-371-7778
Practice Address - Fax:978-369-9514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA55349207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2190590OtherAETNA
MAJ14816OtherBLUE CROSS OF MA
MA2950503005OtherCIGNA
MA36408OtherFALLON
MA055349OtherTUFTS
MAAM1070OtherHARVARD PILGRIM
MA04-04867OtherUNITED HEALTH
MAAM1070OtherHARVARD PILGRIM
MAE30510Medicare UPIN