Provider Demographics
NPI:1720018039
Name:TREVISAN, KAREN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:TREVISAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:TANGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MORSE STREET
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-8700
Mailing Address - Fax:781-769-8704
Practice Address - Street 1:100 MORSE STREET
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-8700
Practice Address - Fax:781-769-8704
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2204552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry