Healthcare Provider Details

I. General information

NPI: 1184014011
Provider Name (Legal Business Name): KTHRYN P. RAPPERPORT, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8 WALLIS CT
LEXINGTON MA
02421-5417
US

IV. Provider business mailing address

8 WALLIS CT
LEXINGTON MA
02421-5417
US

V. Phone/Fax

Practice location:
  • Phone: 781-862-7487
  • Fax:
Mailing address:
  • Phone: 781-862-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number78675
License Number StateMA

VIII. Authorized Official

Name: DR. KATHRYN PORTER RAPPERPORT
Title or Position: OWNER
Credential: MD
Phone: 781-862-7487