Healthcare Provider Details

I. General information

NPI: 1265894166
Provider Name (Legal Business Name): KATHERINE PRYOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST MEDICINE RESIDENCY OFFICE
BOSTON MA
02115-6106
US

IV. Provider business mailing address

75 FRANCIS ST MEDICINE RESIDENCY OFFICE
BOSTON MA
02115-6106
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-8268
  • Fax:
Mailing address:
  • Phone: 617-525-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number281482
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: