Healthcare Provider Details
I. General information
NPI: 1528043999
Provider Name (Legal Business Name): KARIE LIN DEVRIES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/08/2005
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2000 WASHINGTON ST SUITE 764
NEWTON MA
02462-1628
US
IV. Provider business mailing address
2000 WASHINGTON ST SUITE 764
NEWTON MA
02462-1628
US
V. Phone/Fax
- Phone: 617-965-7800
- Fax: 617-965-4581
- Phone: 617-965-7800
- Fax: 617-965-4581
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | 152756 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 0701334 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UNITED HEALTHCARE |
| # 2 | |
| Identifier | S023506 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CHAMPUS |
| # 3 | |
| Identifier | 0025501 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | NEIGHBORHOOD HEALTH |
| # 4 | |
| Identifier | 043200332 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | STANDARD TAX ID |
| # 5 | |
| Identifier | 37704 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHY START |
| # 6 | |
| Identifier | 131410 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HPHC |
| # 7 | |
| Identifier | 152756 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | TUFTS HEALTH PLAN |
| # 8 | |
| Identifier | 160057179 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | RAILROAD MEDICARE |
| # 9 | |
| Identifier | B20430403 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 10 | |
| Identifier | J18034 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BCBS |
| # 11 | |
| Identifier | 152756 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS |
| # 12 | |
| Identifier | 3171345 |
| Identifier Type | MEDICAID |
| Identifier State | MA |
| Identifier Issuer | |
| # 13 | |
| Identifier | 1643449 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHSOURCE MA |
| # 14 | |
| Identifier | 2608539 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA US HEALTHCARE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
