Provider Demographics
NPI:1720511157
Name:BEDARD, KATHRYN ROSE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:BEDARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVENUE
Mailing Address - Street 2:MAILSTOP BCH 3103
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3411
Mailing Address - Country:US
Mailing Address - Phone:617-355-6832
Mailing Address - Fax:617-730-0254
Practice Address - Street 1:300 LONGWOOD AVENUE
Practice Address - Street 2:MAILSTOP BCH 3103
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3411
Practice Address - Country:US
Practice Address - Phone:617-355-6832
Practice Address - Fax:617-730-0254
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287146207RI0200X, 2080P0208X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program