Healthcare Provider Details

I. General information

NPI: 1104355353
Provider Name (Legal Business Name): KATHERINE KONIARES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BOYLSTON ST STE 300
CHESTNUT HILL MA
02467-1976
US

IV. Provider business mailing address

300 BOYLSTON ST STE 300
CHESTNUT HILL MA
02467-1976
US

V. Phone/Fax

Practice location:
  • Phone: 617-449-9750
  • Fax: 617-449-9751
Mailing address:
  • Phone: 617-449-9750
  • Fax: 617-449-9751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number271203
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number1020058
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: