Provider Demographics
NPI:1952362568
Name:COLLINS, KATHRYN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:88 E NEWTON ST
Mailing Address - Street 2:C522
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2658
Mailing Address - Country:US
Mailing Address - Phone:617-638-8488
Mailing Address - Fax:617-638-8469
Practice Address - Street 1:88 E NEWTON ST
Practice Address - Street 2:C522
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2658
Practice Address - Country:US
Practice Address - Phone:617-638-8488
Practice Address - Fax:617-638-8469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2261632086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2111811Medicaid
MA2111811Medicaid