Provider Demographics
NPI:1780847194
Name:DAMICO, KAREN E (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DAMICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 WASHINGTON ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4832
Mailing Address - Country:US
Mailing Address - Phone:978-283-7580
Mailing Address - Fax:978-283-0456
Practice Address - Street 1:298 WASHINGTON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-283-7580
Practice Address - Fax:978-283-0456
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089580AMedicaid
MA110089580AMedicaid
MA002394401Medicare PIN