Healthcare Provider Details

I. General information

NPI: 1952362568
Provider Name (Legal Business Name): KATHRYN A COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 E NEWTON ST C522
BOSTON MA
02118-2658
US

IV. Provider business mailing address

88 E NEWTON ST C522
BOSTON MA
02118-2658
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8488
  • Fax: 617-638-8469
Mailing address:
  • Phone: 617-638-8488
  • Fax: 617-638-8469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number226163
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: