Provider Demographics
NPI:1982673240
Name:ERDODY, KARA K (NP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:K
Last Name:ERDODY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LIBBEY PARKWAY
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189
Mailing Address - Country:US
Mailing Address - Phone:781-682-6030
Mailing Address - Fax:781-682-0695
Practice Address - Street 1:90 LIBBEY PARKWAY
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189
Practice Address - Country:US
Practice Address - Phone:781-682-6030
Practice Address - Fax:781-682-0695
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201546363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369811Medicaid
MAC345OtherHARVARD PILGRIM
MANP3342OtherBLUE CROSS
MANP3342OtherBLUE CROSS
MANP3342Medicare ID - Type Unspecified