Provider Demographics
NPI:1780630442
Name:AYERS, KATHLEEN DAWSON (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DAWSON
Last Name:AYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:CRONIN
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-825-6581
Mailing Address - Fax:978-825-7070
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-741-9500
Practice Address - Fax:978-741-3927
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2086000Medicaid
A37680Medicare ID - Type Unspecified
MA2086000Medicaid