Healthcare Provider Details

I. General information

NPI: 1316268535
Provider Name (Legal Business Name): KATHERINE RATZAN PEELER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE # BADER634 BOSTON CHILDREN'S HOSPITAL, DIVISION OF CRITICAL CARE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE # BADER634 BOSTON CHILDREN'S HOSPITAL, DIVISION OF CRITICAL CARE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7327
  • Fax: 617-730-0453
Mailing address:
  • Phone: 617-355-7327
  • Fax: 617-730-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number254552
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number254552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: