Healthcare Provider Details

I. General information

NPI: 1407804594
Provider Name (Legal Business Name): KATHERINE A O'DONNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVENUE CHILDRENS HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

65 PARK ST APT. 1
BROOKLINE MA
02446-6338
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6363
  • Fax:
Mailing address:
  • Phone: 617-355-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number227313
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: