Provider Demographics
NPI:1821067141
Name:NELSON, KATHLEEN LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 343F
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-338-5680
Mailing Address - Fax:978-338-5681
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 343F
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-338-5680
Practice Address - Fax:978-338-5681
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2009-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA784982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861627317OtherTUFTS
1861627317OtherMEDICARE
1861627317OtherCIGNA
1861627317OtherBLUE CROSS/BLUE SHIELD
1861627317OtherHARVARD PILGRIM HEALTH CARE
1861627317OtherCIGNA