Healthcare Provider Details

I. General information

NPI: 1982802666
Provider Name (Legal Business Name): KATHERINE REICHMANN KAVANAGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ANN REICHMANN

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST 2L
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST 2L
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9650
  • Fax:
Mailing address:
  • Phone: 860-545-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number238623
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number048858
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: