Provider Demographics
NPI:1770656548
Name:CATHLEEN LONDON MD PC
Entity Type:Organization
Organization Name:CATHLEEN LONDON MD PC
Other - Org Name:ALLIANCE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:GREENBERG
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-232-0616
Mailing Address - Street 1:209 HARVARD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5071
Mailing Address - Country:US
Mailing Address - Phone:617-232-0616
Mailing Address - Fax:617-232-0604
Practice Address - Street 1:209 HARVARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5071
Practice Address - Country:US
Practice Address - Phone:617-232-0616
Practice Address - Fax:617-232-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17740OtherBCBS GROUP
MA9707760Medicaid
MAJ19911OtherBCBS INDIVIDUAL
MAG91513Medicare UPIN
MA9707760Medicaid