Provider Demographics
NPI:1669419578
Name:GIFFORD, KATHERINE RHOADS (PAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RHOADS
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:GIFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:15 COLBY RD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4729
Mailing Address - Country:US
Mailing Address - Phone:781-626-1844
Mailing Address - Fax:
Practice Address - Street 1:15 COLBY RD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4729
Practice Address - Country:US
Practice Address - Phone:781-626-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA68363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000025874OtherBMC HEALTHNET
MA9771247Medicaid
MA604436OtherTUFTS HEALTH PLAN
MAH2672OtherRAILROAD MEDICARE
MAS722OtherHARVARD PILGRIM
MA604436OtherSECURE HORIZONS
MAM15296OtherBCBS MA
MAAP0189Medicare ID - Type Unspecified
MAS722OtherHARVARD PILGRIM
MA9771247Medicaid