Healthcare Provider Details

I. General information

NPI: 1649241464
Provider Name (Legal Business Name): KATHERINE PENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 CHATHAM RD
HARWICH MA
02645-3309
US

IV. Provider business mailing address

PO BOX 1413
WELLFLEET MA
02667-1413
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-1400
  • Fax: 508-430-2333
Mailing address:
  • Phone: 508-905-2800
  • Fax: 508-240-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: