Healthcare Provider Details

I. General information

NPI: 1124046644
Provider Name (Legal Business Name): KATHRYN E ACKERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GUEST ST STE 200
BRIGHTON MA
02135-2040
US

IV. Provider business mailing address

20 GUEST ST STE 200
BRIGHTON MA
02135-2040
US

V. Phone/Fax

Practice location:
  • Phone: 617-362-6450
  • Fax: 617-362-6460
Mailing address:
  • Phone: 617-362-6450
  • Fax: 617-362-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number228833
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number228833
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number228833
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: