Healthcare Provider Details

I. General information

NPI: 1235724220
Provider Name (Legal Business Name): MARY KATHRYN O'DONOGHUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHRYN KLINE CRNA

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

IV. Provider business mailing address

108 ORCHARD VIEW DR
DOUGLASSVILLE PA
19518-9237
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6000
  • Fax:
Mailing address:
  • Phone: 610-334-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN672208
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: