Healthcare Provider Details

I. General information

NPI: 1831141688
Provider Name (Legal Business Name): KATHLEEN M OGRADY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 MAPLE AVE
SHREWSBURY MA
01545-2673
US

IV. Provider business mailing address

5 NEPONSET ST FL STREET2
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-595-2513
  • Fax: 508-595-2021
Mailing address:
  • Phone: 508-368-5532
  • Fax: 508-595-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: