Provider Demographics
NPI:1700851029
Name:CARR, KATHRYN KRAVETZ (CNM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KRAVETZ
Last Name:CARR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:KRAVETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:WOMEN'S HEALTH PAVILLION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-562-7007
Mailing Address - Fax:617-562-7008
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:WOMEN'S HEALTH PAVILLION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-562-7007
Practice Address - Fax:617-562-7008
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256287176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705381Medicaid
MAQ62805Medicare UPIN