Provider Demographics
NPI:1891785358
Name:STANSMORE, KATHARINE OLIVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:OLIVIA
Last Name:STANSMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:781-487-6000
Mailing Address - Fax:781-487-2978
Practice Address - Street 1:55 FRUIT ST YAW 5
Practice Address - Street 2:CARDIAC UNIT ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203131207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28364OtherBCBS MA
MA356103OtherTUFTS HEALTH PLAN
MA2094240Medicaid
H41369Medicare UPIN
MA2094240Medicaid