Provider Demographics
NPI:1184014011
Name:KTHRYN P. RAPPERPORT, MD, PC
Entity type:Organization
Organization Name:KTHRYN P. RAPPERPORT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:RAPPERPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-862-7487
Mailing Address - Street 1:8 WALLIS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5417
Mailing Address - Country:US
Mailing Address - Phone:781-862-7487
Mailing Address - Fax:
Practice Address - Street 1:8 WALLIS CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5417
Practice Address - Country:US
Practice Address - Phone:781-862-7487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78675103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110053938BMedicaid
MAY02839Medicare PIN