Healthcare Provider Details

I. General information

NPI: 1780946111
Provider Name (Legal Business Name): CATHERINE MYGATT NADEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HAVERHILL ST 3RD FLOOR RESIDENCY
LAWRENCE MA
01841-2884
US

IV. Provider business mailing address

915 COMMONWEALTH AVE
BOSTON MA
02215-1394
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-0090
  • Fax: 978-687-2106
Mailing address:
  • Phone: 617-358-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number252020
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: