Healthcare Provider Details

I. General information

NPI: 1508852328
Provider Name (Legal Business Name): KATHLEEN M ANKERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1198
US

IV. Provider business mailing address

PO BOX 295
ANDOVER MA
01810-0005
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2000
  • Fax:
Mailing address:
  • Phone: 781-687-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD043090L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number234012
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: