Provider Demographics
NPI:1982622841
Name:VANSAVAGE, KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:VANSAVAGE
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 1:20 RESEARCH PL STE 320
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2455
Mailing Address - Country:US
Mailing Address - Phone:978-256-1858
Mailing Address - Fax:978-788-7890
Practice Address - Street 1:20 RESEARCH PL STE 320
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2455
Practice Address - Country:US
Practice Address - Phone:978-256-1858
Practice Address - Fax:978-788-7890
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0170178Medicaid
MAH62796Medicare UPIN
MA0170178Medicaid