Provider Demographics
NPI:1922056035
Name:DEANZERIS, KATHRYN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:DEANZERIS
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 1:40 WALNUT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2175
Mailing Address - Country:US
Mailing Address - Phone:781-235-1224
Mailing Address - Fax:781-235-4111
Practice Address - Street 1:40 WALNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2175
Practice Address - Country:US
Practice Address - Phone:781-235-1224
Practice Address - Fax:781-235-4111
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2113279Medicaid
A38709Medicare PIN
A3870901Medicare PIN
I33472Medicare UPIN